bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nuclear Cardiology
Authors: Zaret Barry L. 
Published: November 2015

Abstract
Nuclear cardiology is generally considered a clinical phenomenon of the past four decades. However, the field has its roots in earlier times. This chapter focuses on these historical roots as they have evolved into the present era. The initial application of radioisotopes to cardiac studies occurred in the mid-1920s. Ventricular function was evaluated in the 1960s and 1970s by first pass and equilibrium techniques. Myocardial stress perfusion imaging was first performed using potassium-43 and exercise in 1973. Stress imaging rapidly evolved thereafter with new tracers (thallium-201 and technetium-labeled agents) and from planar to SPECT approaches. Perfusion imaging rapidly proved its value diagnostically and in assessing prognosis. Infarct imaging reached its peak use in the 1970s but is now no longer employed. Advances in hybrid imaging, combining CT with radionuclide imaging has recently allowed attenuation correction as well as providing the combination of anatomic and physiologic data. PET myocardial perfusion studies have recently become a standard approach for evaluating perfusion, absolute coronary blood flow and coronary reserve. PET FDG studies of cardiac sarcoidosis have recently been established as a new approach for defining myocardial inflammation. New SPECT systems provide high sensitivity, high resolution studies, allowing for radiation dose reduction and high quality imaging studies.
Radionuclide Angiography
Authors: Sanghani Rupa Mehta , Williams Kim Allan 
Published: November 2015

Abstract
This chapter discusses the technique and use of radionuclide angiography with planar and tomographic imaging. Planar techniques have given way to tomographic imaging in recent years. An overview of RNA is given, including technical issues such as radiopharmaceutical administration, and performance aspects including image acquisition and data interpretation. First-pass RNA (FPRNA), gated planar equilibrium RNA (ERNA) and gated tomographic equilibrium blood pool imaging (GBP-SPECT) are discussed in detail. The use of RNA in select patient populations, including coronary artery disease, valvular disease and for monitoring chemotherapy is discussed. In addition, the use of RNA for the assessment of dyssynchrony is discussed.
Gated SPECT MPI
Authors: Cerqueira Manuel D. 
Published: November 2015

Abstract
Protocols for SPECT MPI have evolved over the last 40-years based on the following factors: available radiotracers and gamma camera imaging systems, alternative methods of stress, the needs and demands of patients and referring physicians, the need for radiation dose reduction and optimization of laboratory efficiency. Initially studies were performed using dynamic exercise planar multi-day Thallium-201 (Tl-201) studies. Pharmacologic stress agents were not available and novel methods of stress included swallowed esophageal pacing leads, cold presser limb emersion, direct atrial pacing, crushed dipyridamole tablets and even the use of intravenous ergonovine maleate. Eventually intravenous dobutamine, dipyridamole, adenosine and regadenoson became available to allow reliable and safe pharmacologic stress for patients unable to exercise. Tomographic SPECT camera systems replaced planar units and Tc-99m agents offered better imaging characteristics over Tl-201. These gamma camera systems, radiopharmaceutical agents and pharmacologic stress agents were all available by the mid-1990s and still represent the majority of MPI being performed today.
Myocardial Perfusion Imaging Before and After Cardiac Revascularization
Authors: AlJaroudi Wael 
Published: November 2015

Abstract
Coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide. While the burden of the disease remains high, the rates of death attributable to CAD have declined by almost a third between 1998 and 2008. In patients with stable ischemic heart disease (SIHD), data supporting survival benefit from coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) versus no revascularization are outdated with the recent advancement in medical therapy. Over the years, myocardial perfusion imaging (MPI) has played a significant role in detecting ischemic burden, risk stratifying patients and guiding physicians to the best treatment strategy. Contrary to data from other trials, the role of stress MPI has been downplayed in more contemporary randomized clinical trial that failed to show that ischemic burden identifies the ideal candidate for revascularization or carries incremental prognostic value. Hence, there is an equipoise on the role of MPI in the management of patients prior to revascularization. The role of stress MPI post-revascularization has also been evaluated in multiple studies, mostly done in the last decade or prior. The guidelines advocate against routine stress MPI in asymptomatic patients (unless 5 years or more post-CABG), but allows it in the presence or recurrence of symptoms. The current chapter will review the data on survival benefit from revascularization, complementary role of stress MPI in selecting the appropriate candidate for revascularization, prognostic value of ischemic versus atherosclerotic burden, role of MPI post revascularization, updated guidelines and proposed algorithms to guide the treating physicians.
Screening Asymptomatic Subjects
Authors: Hage Fadi G. , Farag Ayman , Zoghbi Gilbert J. 
Published: November 2015

Abstract
Cardiovascular disease is the leading cause of death in the United States and accounts for more deaths than all cancers combined. Many apparently healthy adults first present to the health system with a myocardial infarction or sudden cardiac death. It is therefore imperative to assess the risk of cardiovascular events among currently asymptomatic individuals to try and intervene early in the disease process to prevent future events. Risk factors for the development of coronary artery disease in particular, and cardiovascular disease in general, have been identified from epidemiological studies and used to develop global risk scores to risk stratify populations. Although these scores work well at the level of the population, unfortunately they are imperfect at estimating risk at the level of the individual. In this Chapter we will discuss the use of exercise stress testing and other imaging modalities as screening methods for the detection of coronary disease and predicting risk in asymptomatic adults. The hope is to develop a screening program to identify cardiovascular disease early in the disease process to introduce interventions that will favorably impact outcomes in a manner similar to the current screening programs available for several cancers.
Role of Imaging in Chronic Kidney Disease
Authors: Ather Sameer , Farag Ayman , Bhatia Vikas , Hage Fadi G. 
Published: November 2015

Abstract
Cardiovascular disease is highly prevalent in patients with chronic kidney disease (CKD) and is the biggest contributor of death in these patients. Myocardial perfusion imaging (MPI) is a validated tool for diagnosing coronary artery disease (CAD) and for predicting short and long term prognosis in this patient population. Non-invasive stress imaging, with MPI or other imaging modalities, is widely used for risk stratification in patients with end-stage renal disease (ESRD) being evaluated for kidney transplantation due to the paucity of donor organs and the high cardiovascular risk of patients on the transplant waiting list. In this Chapter we will review the data on diagnostic accuracy and risk stratification using MPI in patients with CKD and ESRD highlighting the special challenges that are unique to this population. We will also discuss novel indicators that have been used in these patients to improve risk stratification.
Imaging Patients with Chest Pain in the Emergency Department
Authors: Soman Prem , Udelson James E. 
Published: November 2015

Abstract
The six-to-eight million people who present to emergency departments (EDs) across the U.S. each year for the evaluation of chest pain present a unique challenge to physicians.(1) Less than a third of these patients are eventually diagnosed with coronary artery disease (CAD).(2,3) However, a small percentage of patients with acute cardiac ischemia and an acute coronary syndrome (ACS) are inadvertently discharged, with potential adverse consequences.(2,4-6) Concerns about patient safety and malpractice litigation has resulted in the adoption of a practice paradigm that involves observation and testing that is associated with high cost. In this chapter we review the current approaches to risk stratification of chest pain patients, the utility of myocardial perfusion imaging for this purpose and, the ongoing investigation of potential new approaches in this area.
Role of PET in Diagnosis and Risk Assessment in Patients with Known or Suspected CAD
Authors: Mc Ardle Brian A. , Renaud Jennifer M. , deKemp Robert A. , Beanlands Rob S. B. 
Published: November 2015

Abstract
Cardiac PET enables evaluation of multiple aspects of myocardial perfusion, metabolism, cell signaling and function that are of value both for diagnosis and prognostication in patients with known or suspected CAD and its use has increased in the past three decades. PET myocardial perfusion imaging (MPI) offers several technological advantages over SPECT including; higher photon energy, higher count sensitivity, more consistent attenuation correction and the ability to measure myocardial blood flow in absolute terms. These result in faster imaging times, lower patient radiation exposure and increased diagnostic accuracy. However the availability of PET MPI remains limited, predominantly due to expense. Efforts are underway to expand the use of PET MPI beyond larger centers, with lower-cost scanners and more widely available radiotracers. In this chapter we describe the latest advances in PET camera technology and image reconstruction as well as potential image artifacts specific to PET MPI. We go on to discuss diagnostic accuracy and prognostic value of PET MPI as well as its role in clinical practice.
Phase Analysis for Dyssynchrony by MPI and MUGA
Authors: Chen Ji 
Published: November 2015

Abstract
Fourier phase analysis can be used to assess dyssynchrony from nuclear images, such as multi-gated acquisition (MUGA) radionuclide angiography, gated blood-pool SPECT, and gated SPECT myocardial perfusion imaging. This chapter reviews the technical background of Fourier phase analysis with these imaging modalities and demonstrates how it measures ventricular dyssynchrony. The major clinical application of ventricular dyssynchrony assessment is to improve response to cardiac resynchronization (CRT) in patients with heart failure. This chapter introduces the current practice of CRT and the potential factors related to CRT response, and then reviews the clinical studies of the above phase analysis techniques for increasing CRT response.
Imaging of Myocardial Innervation
Authors: Masuda Atsuro , Naya Masanao , Yoshinaga Keiichiro , Tamaki Nagara 
Published: November 2015

Abstract
Cardiac autonomic innervation imaging has been focused on assessing molecular, electrophysiologic, and pathophysiologic processes of various cardiac disorders. Iodine radiotracer (I-123)-labeled metaiodobenzylguanidine (MIBG), as a marker of adrenergic neuron function, plays an important role in risk stratification and treatment monitoring of heart failure patients. In addition, MIBG has a potential value for predicting fatal arrhythmias that may require implantable cardioverter-defibrillator treatment. Among various positron emission tomography (PET) tracers for probing autonomic neuronal function, C-11 hydroxyephedrine (HED), has been used for precise assessment of heart failure and arrhythmias, similar to MIBG. More studies are needed to confirm the clinical utility of these molecular imaging modalities for the management of patients with heart failure, coronary artery disease and arrhythmias.
Image-Based Measurements of Myocardial Blood Flow
Authors: Schelbert Heinrich R. 
Published: November 2015

Abstract
Image-based measurements of myocardial blood flow afford the assessment of coronary circulatory function. They reflect functional consequences of coronary stenoses, diffuse epicardial vessel disease and microvascular dysfunction and structural changes and thus provide a measure of the total ischemic burden. Measured flows contain therefore clinically important predictive information. Fundamental to flow measurements are the tissue tracer kinetics, their description through tracer kinetic models, high spatial and temporal resolution imaging devices and accurate extraction of radiotracer tissue concentrations from dynamically acquired images for estimating true flows from the tissue time activity curves. A large body of literature on measurements of myocardial blood flow exists for defining in humans normal values for flow at baseline and during hyperemic stress as well as for the myocardial flow reserve. The role of PET for flow measurements has been well established; initial results with modern SPECT devices are encouraging. Responses of myocardial blood flow to specific challenges like pharmacologic vasodilation and to sympathetic stimulation can uncover functional consequences of focal epicardial coronary stenoses, of conduit vessel disturbances and disease and impairments of microvascular function. Apart from risk stratification, flow measurements may allow detection of early preclinical disease, influence treatment strategies and identify therapy responses.
Imaging of Myocardial Metabolism
Authors: Gropler Robert J. 
Published: November 2015

Abstract
Abnormalities in myocardial substrate metabolism play a key role in the pathogenesis of a host of cardiac disease processes. The importance is highlighted by the routine clinical use of positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) to measure myocardial glucose metabolism to detect viable tissue in patients with ischemic cardiomyopathy and the development of novel therapies designed to modulate myocardial metabolism. Our understanding of myocardial metabolism has benefitted from the application of advanced molecular biologic techniques and the development of elegant genetic models to of myocardial metabolic disease resulting in a greater appreciation for the pleiotropic actions of cellular metabolism. In parallel, there have been significant advances in radionuclide-based metabolic imaging techniques in terms instrumentation design, radiopharmaceutical development and small animal imaging. These advances have further ensconced radionuclide metabolic imaging techniques as tools to further our understanding of various forms of cardiovascular disease and potentially improve the care of the cardiac patient. In this chapter several of key advances in metabolic imaging will be described, their potential new clinical applications are reviewed and contribution to cardiovascular research highlighted.
Radionuclide Imaging in Heart Failure
Authors: Soman Prem 
Published: November 2015

Abstract
Heart Failure is a clinical syndrome characterized by symptoms and signs of systemic or pulmonary congestion, associated with elevated intracardiac filling pressures. The structural and functional abnormalities of the myocardium which characterize the heart failure state can be explored by various imaging approaches. Hence cardiac imaging plays an integral part in the evaluation the heart failure patient. Radionuclide imaging techniques may be uniquely suited to address several important clinical questions in heart failure related to etiology, the quantification and serial evaluation of LV function, and the selection of patients for therapies including coronary revascularization, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy (CRT).
Hybrid Cardiac Imaging
Authors: Kaufmann Philipp A. , Gaemperli Oliver 
Published: November 2015

Abstract
Assessment of both coronary anatomy and myocardial perfusion are equally important for the appropriate treatment of patients with stable coronary artery disease. Cardiac hybrid imaging allows integration of coronary anatomy and perfusion in one all-in-one image, thereby avoiding mental integration of findings. In selected subgroups of patients, cardiac hybrid imaging has demonstrated superior diagnostic accuracy compared to single modalities. The combination of coronary anatomy and function provides incremental prognostic information and improves risk stratification of patients with suspected or known CAD. Aside from CT coronary angiography, coronary artery calcium score (CACS) scans obtained from native ECG-triggered CT are used for hybrid imaging. They are used either for attenuation correction, or can be combined with radionuclide information to improve CAD detection and risk stratification. A large number of integrated hybrid scanners are commercially available and offer advantages for cardiac hybrid imaging. However, these devices are not mandatory, and hybrid imaging is perfectly feasible from two separate datasets using appropriate image fusion software. Cardiac magnetic resonance has entered the arena of hybrid imaging and several integrated PET/MRI devices are already commercially available. Its advantages include the lack of ionizing radiation and a high spatial resolution, particularly for soft tissue structures. In research, hybrid imaging moves beyond its conventional borders of perfusion imaging to target specific molecular or biological pathways that underlie cardiac disease, a concept known as molecular imaging. The combination of radionuclide imaging with CT or MRI offers attractive features to co-localize biological signals from radiolabeled targeted compounds with microanatomical structures.
Cost Effectiveness of Imaging with Nuclear Cardiology
Authors: Phillips Lawrence M. , Shaw Leslee J. 
Published: November 2015

Abstract
This chapter focuses on the economic data available for cardiovascular (CV) imaging. The total costs of testing are substantively lower than those associated with invasive procedures. There are several ongoing randomized trials, such as the PROMISE trial, that may further add to our evidence base on the cost implications of CV imaging. Data for stress nuclear cardiology supports its utility in terms of a high prognostic accuracy and that this test is economically attractive; notably for patients with a high likelihood of coronary artery disease. Data also supports that this benefit does not only include patients with known coronary artery disease but also the high likelihood subsets of the elderly or functionally impaired where ischemic findings play a fundamental role in ischemia-guided management. Importantly, more recent data support that alternative testing strategies have reduced cost in subsets of patients including lower risk women with stable chest pain and in the acute evaluation of low risk chest pain in the ED. Negative evidence is extremely important for the field of CV imaging and this more recent data should be embraced as defining our limitations in nuclear cardiology.
Iliac artery occlusions: surgical bypass, covered and uncovered stents
Authors: Christie Andrew , Robertson Iain 
Published: November 2015

Abstract
The Trans-Atlantic Intersociety Consensus (TASC) is the landmark publication offering guidance on endovascular versus surgical treatment of iliac disease. The discussion is based upon a patient with TASC C occlusive morphology. The technical aspects of endovascular treatment and their potential complications are discussed, as well as variations in practice. Emphasis is also placed on outcome measures with comparison to standard surgical alternatives for bypassing complex iliac lesions. A comprehensive review of the literature is provided, and the potential pitfalls of pre-procedure imaging are highlighted.
Thrombolysis for acute lower limb ischaemia
Authors: Diamantopoulos Athanasios , Gkoutzios Panos 
Published: November 2015

Abstract
Since its introduction by Dotter, catheter directed thrombolysis has been established as an effective treatment option for patients suffering from acute limb ischaemia (ALI). We present the case of a 57-year-old female patient who was admitted with ALI symptoms in her left leg with moderate motor and sensory loss. Her previous medical history included a right common iliac artery to right common femoral artery (CFA) bypass followed by right CFA to left CFA and a left CFA to left popliteal artery bypass using a synthetic graft one year prior to admission. Pre-procedural imaging with computer tomography angiography revealed that both the right to left femoral-femoral bypass graft and the femoral-popliteal bypass grafts were thrombosed, with flow reconstituting at the popliteal artery. After establishment of endovascular access, thrombolysis was initiated as per the institutional protocol and the patient was then transferred to a high dependency unit for monitoring. After 24 hours, digital subtraction angiography showed satisfactory flow in both the right to left femoral-femoral graft and the left side femoral-popliteal graft with no significant underlying lesions being present. The anterior tibial artery was patent to the foot. The patient had regained full motion and sensory feeling of the previous ischaemic limb and the distal foot was significantly warmer than before the procedure. Catheter-directed thrombolysis techniques and results are discussed.
Renal artery stenosis: angioplasty or stent?
Authors: Prabhudesai Shirish , Gupta Yuri , Karunanithy Narayan 
Published: November 2015

Abstract
Renal artery stenosis impedes blood flow and can result in refractory hypertension, congestive heart failure, and progressively worsening renal function. This case discusses the indications for treatment, endovascular technique, and procedural considerations, and provides a literature review of currently available evidence.
IVC filters and anticoagulation
Authors: Burke Christopher , Krokidis Miltiadis , Hoppe Hanno 
Published: November 2015

Abstract
Inferior vena cava (IVC) filters, which are usually deployed via the common femoral or internal jugular veins, were initially intended for use in patients who had venous thromboembolism (VTE) and a contraindication to anticoagulation, a complication of anticoagulation, inability to achieve adequate anticoagulation, or recurrent pulmonary embolism despite anticoagulation. These indications have been expanded to include some patients with high VTE risk but no evidence of VTE. The development of retrievable filter designs has extended the clinical utility for IVC filters. This case demonstrates the decision-making process in filter deployment, describes some technical aspects of the procedure, and discusses the current literature on the use of IVC filters.
TIPS and TIPS revision for Budd–Chiari patients
Authors: Pavlidis Vyzantios , Brountzos Elias 
Published: November 2015

Abstract
Budd-Chiari syndrome (BCS) is a relatively rare condition, with potentially life-threatening outcomes in untreated patients. Although transjugular intrahepatic portosystemic shunt (TIPS) with the use of PTFE-covered stent-grafts is an efficient minimal invasive treatment, variations of the technique have been described according to the degree of hepatic vein thrombosis. However, the underlying thrombotic tendency in such patients may cause a high rate of shunt restenosis or occlusion. Interventional recanalization of the shunt is possible, but is not always successful. Management of such cases of total shunt occlusion may involve the creation of a new shunt. This challenging procedure is technically feasible and seems to prolong survival as well as being an alternative to early transplantation.