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Cardiovascular Imaging

1st Faculty of Medicine, Charles University in Prague Center for Advanced Preclinical Imaging (CAPI)

1st Faculty of Medicine, Charles University in Prague

Center for Advanced Preclinical Imaging (CAPI)


Center for Advanced Preclinical Imaging (CAPI) [email protected]

Cardiovascular ImagingCardio and Vascular Imaging

• Vascularization / Angiogenesis

• Cardiovascular Imaging

metabolic imaging of the heart

myocardial perfusion imaging

Cardiac CT



Vascularization / Angiogenesis

• Vascularization / Angiogenesis

Developmental Angiogenesis

Tumor Angiogenesis



Developmental Angiogenesis

• Misclassification of vascular anomalies remains common despite

fundamental pathologic differences

• An accurate distinction is important for management:

– Though most hemangiomas spontaneously resolve,

approximately 10-20% will warrant pharmacologic, surgical, or

laser intervention

– Percutaneous sclerotherapy or more invasive transarterial

embolization is used to treat vascular malformations depending

on whether the lesion is high-flow or low-flow



Vascular Anomaly Diagnosis

• Most often a clinical

diagnosis

• Radiologic imaging provides

a role in challenging cases

and can be used to assess

the depth and extent of the

lesion

– Ultrasound: provides

excellent characterization

of superficial structures and

hemodynamics

– MRI: single best exam due

to its strong soft tissue

contrast and ability to

define extent of the lesion

and involvement with

nearby structures

http://www.adhb.govt.nz/newborn/teachingresources/dermatology/VascularLesions.htm



Hemangioma2 year old female – left gluteal hemangioma

Spectral color doppler US image demonstrates a

well-defined heterogenous mass with arterial

waveform Sagittal T1W with fat saturation post

contrast MR image demonstrates avid and

homogenous enhancement of the mass



Arteriovenous Malformation12 week old female – right scapular AVM

Spectral color Doppler US image demonstrates a

waveform typical for low arterial resistance with

arterialization of the draining veins Coronal T1 with fat saturation post contrast MR

image demonstrate avid enhancement of the

lesion



Tumor Angiogenesis

Molecular imaging of the αvβ3 integrin:

A - SPECT

B - PET

C - optical imaging

D - MRI

E - xenograft tumor after injection of microbubbles conjugated with ariginine-glycine-aspartic acid (RGD)

F - xenograft tumor after injection of microbubbles conjugated with scrambled control peptide

G - presence of single microbubbles after injection of αvβ3-targeted microbubbles



Tumor AngiogenesisDynamic contrast enhanced MRI (DCE_MRI)

• Technique where enhancement of a tissue or organ is continuously monitored using MRI after bolus IV contrast medium

– Low molecular weight contrast media (<1 kDa)

– Diffuse into extravascular-extracellular space (does not cross cell membranes)

– Experiment lasts a few minutesDavid Collins and Ian Judson, Institute of cancer Research, London



Basics of DCE-MRI



Basics of DCE-MRIT2*W DCE-MRI of Mixed Mullerian Tumour

Typical acquisition 1-2 mins



Cardiovascular ImagingMyocardial Perfusion



Myocardial Perfusion

• Schematic representation of interpretation of myocardial perfusion

images

• Shaded areas indicate myocardial perfusion defects




• Summed images are used to assess cardiac perfusion. Rest and Stress

images are compared to determine if a region of the heart is “ischemic” –

starved of oxygen

• In the study below, the rest image indicates normal blood flow, but the stress

image indicates abnormal blood flow in the Inferior-lateral region.

• This may indicate “ischemia” in this region of the heart – which is supplied by

the LCX (left circumflex artery). There may be stenosis in that coronary artery.

Stress

Rest



• Gated images are made

possible by ECG-gated

SPECT

• Physicians can now

access cardiac function:

• Wall motion – does the

LV contract uniformly?

• Ejection Fraction – does

the LV pump out enough

blood to the body?

SA

HLA

VLA





82Rb PET: left normal; right abnormal perfusion study






Cardiac CT

Clinical Scanners

• High temporal and spatial

resolution

• Gantry rotation times of 420

ms or shorter

• Spatial resolution of 0.4 by 0.4

by 0.4 mm

• “state-of-the-art” equipment for

CTA

• Breath hold is 6 to 12 s



Cardiac CTCoronary Artery Calcium Scanning

• Non-contrast study

• Refine clinically predicted risk

of CHD beyond that predicted

by standard cardiac risk factors

• Used in asymptomatic patients

• Coronary calcium Present in

direct proportion to extent of

atherosclerosis

• Minority (20%) of plaque is

calcified



Cardiac MRIQuantitative Data on ventricular chambers

(a) Coronal scout; (b) end-

diastolic image in axial

projection; (c) end-diastolic

image

on long vertical axis; (d)

end-diastolic image on

long horizontal axis; (e)

end-diastolic image on

long vertical axis that is

used in alternative for

obtaining images on the

short axis; (f) end-diastolic

image on short axis at

medium ventricular level

that is used in alternative

for obtaining images on

the long horizontal axis



Myocardial MetabolismFatty Acid Metabolism




Serial dynamic images (2 mm per frame) of myocardiumafter administra tion

of [â€˜1C]palmitatotehealthy volunteer. Note high myocardial uptake in early

stage, with rapidwashoutfrom myocardium.




Series of short-axisslices of

(A) resting and

(B) delayed thallium (TL) scans and

(C) BMIPPscan of patient with

unstable angina. Although thallium

did not show definite perfusion

abnormalities,decreased BMIPP

uptake was notedin lateral region.



Myocardial Metabolism18F-FDG

[18F] FDG cardiac PET/CT in a normal mouse (top) and in a mouse with myocardial

infarction (lower). FDG cardiac uptake is uniform in the normal mouse, while there

is an area of absent uptake in the anteroapical region of the mouse with myocardial

infarction.



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Ověřování biochemických a farmakologických ... · approximately 10-20% will warrant pharmacologic, ... Ověřování biochemických a farmakologických vlastností radioaktivně