bluuebunny/crossref_metadata_2025_split huggingface dataset:
Essentials of Nuclear Cardiac Imaging
Authors: Iskandrian Ami E. , Hage Fadi G. , Bhambhvani Pradeep , Garcia Ernest V. 
Published: February 2024

Abstract
This chapter is a quick reference to common questions encountered by practitioners in the field on a regular basis. It is intended to be short, concise, and accurate. We do not provide references, tables, or figures; these belong in the chapters, and there are plenty of them. The opinions expressed are those of the authors. We could have selected a thousand more questions, but we opted for a few common and recurring ones. We recognize that some of the measurements discussed here could be made just as good or even better by other imaging modalities, but our emphasis is on nuclear imaging. The nature of these questions is either technical or clinical, as it should be, and if we missed a burning question in your mind, we apologize in advance. We adopted the rule of 10—devoting 10 points to answer each question.
Radiation Physics and Radiation Safety
Authors: Murphy Paul H. , Galt James R. 
Published: February 2024

Abstract
Nuclear cardiology requires tracers, or radiopharmaceuticals, based on radionuclides that provide photons suitable for imaging, give a radiation dose to the patient that is as low as possible, and can be handled safely by personnel. Atomic processes involve the whole atom (the nucleus and its bound electrons), while nuclear processes are restricted to the nucleus (neutrons and protons). All emissions that radiate from atoms and nuclei are due to excess energy and are released in order to reach a stable ground state. X-rays are produced outside of the nucleus, while alpha particles, beta particles, and gamma rays originate inside the nucleus. As radiation in the form of rays and particles travels through tissue, it imparts energy to the tissue that can result in damage. Dosimetry is the measurement of this radiation absorbed dose. Radionuclides that are used in nuclear cardiology can be produced in nuclear reactors, in particle accelerators called cyclotrons, or in portable devices called generators. Handling and administering radiopharmaceuticals requires strict attention to radiation safety and to the principle of ALARA.
Gated SPECT MPI
Authors: Henzlova Milena J. , McMahon Sean R. , Duvall W. Lane 
Published: February 2024

Abstract
The acquisition of high-quality nuclear cardiac imaging requires coordination of a number of elements that are optimized for each patient. Equipment must be calibrated and up to date while lab personnel need to be proficient with pre-imaging quality control, imaging protocols, and processing. Three radiotracers for myocardial perfusion imaging are currently available for clinical use in the United States: thallium 201 (Tl-201) and two technetium-99m (Tc-99m)-labeled agents, Tc-99m sestamibi and Tc-99m tetrofosmin. Myocardial perfusion imaging protocols respect the characteristics of available radiotracers, with Tc-99m-based 1-day, rest–stress protocols being the most common. Imaging has been performed for decades with conventional NaI SPECT cameras but new, more efficient solid-state cameras now allow for either lower tracer dose or shorter imaging time, or a combination of both.
Diagnosis and Risk Assessment with SPECT MPI
Authors: Gomez Javier , Doukky Rami 
Published: February 2024

Abstract
Over the last four decades, the diagnostic and prognostic value of MPI with SPECT has been established by a wealth of data. The value of SPECT MPI has been consistently demonstrated regardless of the stress modality, radiotracer, or instrumentation used. The diagnostic performance of MPI depends on the pretest probability of CAD in the population studied, with the highest yield being among patients with an intermediate pretest probability. The excellent prognostic value of a normal SPECT MPI has been documented in tens of thousands of patients, conferring an annualized MACE risk of less than 1% for exercise stress and less than 1.5% for pharmacologic stress. An abnormal SPECT MPI is associated with a multi-fold increase in the risk of MACE with multiple factors predicting high risk, such as the presence, extent, reversibility, severity, and number of perfusion abnormalities. Furthermore, several non-perfusion variables are associated with increased risk; these include LV dysfunction, TID, and abnormal lung uptake. The incorporation of CACS from hybrid SPECT/CT systems adds incremental prognostic value beyond perfusion data alone. The use of SPECT MPI as a gatekeeper to ICA has been shown to be cost-effective, reducing rates of coronary angiography and revascularization and their associated costs, without a significant difference in cardiovascular outcomes. In summary, the use of SPECT MPI for detection and prognostication of CAD is supported by a vast amount of data and decades of clinical use. SPECT MPI can guide management decisions, can identify patients likely to benefit from revascularization, and is cost-effective.
Evaluation of Patients with Chest Pain in the Emergency Department
Authors: Kaso Elona Rrapo , Bourque Jamieson M. 
Published: February 2024

Abstract
This chapter on the evaluation of patients with chest pain who present to the ED examines the unique benefits and challenges of applying nuclear cardiac and other noninvasive imaging modalities in the triage and management of patients in this care setting. It reviews the robust evidence for SPECT MPI and new advances in this imaging modality. SPECT MPI results in a comprehensive evaluation with increased prognostic and diagnostic value and superior clinical outcomes as well as reductions in cost, hospitalizations, and inappropriate discharges from the ED. The unique advantages and challenges of PET MPI will also be discussed, including specific populations in which this advanced modality is most likely to be helpful, such as evaluation of microvascular angina. Sections on the use of acute chest pain rest imaging and the role and utility of noninvasive imaging in the era of high-sensitivity troponin are included. The chapter will conclude with analysis of the comparative effectiveness and relative strengths and weaknesses of the use of stress echocardiography, stress cardiovascular magnetic resonance imaging, and computed tomographic coronary angiography in evaluation of chest pain in the ED.
Imaging Sarcoid Heart Disease
Authors: Rosenthal David G. , Bravo Paco E. 
Published: February 2024

Abstract
Cardiac sarcoidosis is a chronic inflammatory disorder that can affect the heart in up to one-fifth of cases, often coexists with myocardial fibrosis, and can lead to sudden cardiac death and heart failure progression. It is characterized by infiltration of noncaseating granulomas anywhere within the myocardium and surrounding tissues, most commonly affecting the basal segments of the interventricular septum. Recent advancements in the early diagnosis, risk stratification, and monitoring of disease activity have improved and changed the approach to the management of this complex condition. The present chapter summarizes the current contemporary use of advanced cardiovascular imaging in the evaluation and management of individuals with suspected or known cardiac sarcoidosis.
Imaging Amyloid Heart Disease
Authors: Bois John P. , Grogan Martha , Chareonthaitawee Panithaya 
Published: February 2024

Abstract
Advanced cardiac imaging coupled with heightened clinical awareness has resulted in the recognition of the increasing role of cardiac amyloidosis (CA) in patients with heart failure with preserved ejection fraction. Light chain (AL) and transthyretin (ATTR) CA are the two most common subtypes of amyloid that involve the heart; if unrecognized, high morbidity and mortality result. Unfortunately, diagnosis is often delayed 2 to 3 years from symptom onset. In the current era of rapid development of new therapeutic agents to treat CA, timely diagnosis is critical not only for diagnostic purposes but also for prognostic and therapeutic ones. Nuclear cardiac imaging has emerged as a leading diagnostic tool that has transformed the management of this population. The most utilized radiotracers to date are the radiolabeled bisphosphonate agents (such as 99mTc pyrophosphate), which demonstrate robust uptake in ATTR CA relative to AL and in the right clinical context (including serologic assessment of AL) can differentiate between the two CA subtypes. Furthermore, these radiotracers are widely available and relatively straightforward to utilize and interpret. Conversely, direct amyloid SPECT and PET imaging agents have been hampered by their higher cost, lower availability, lack of FDA approval, and general inability to differentiate between ATTR and AL amyloid. However, agents such as 18F-florbetaben are emerging that demonstrate the potential to differentiate among amyloid subtypes. Future investigations are warranted to determine appropriate use of myocardial scintigraphy agents for screening different populations for amyloidosis and assessing their role in therapeutic decision-making.
Gastroesophageal Reflux Disease
Authors: Kamboj Amrit K. , Murray Joseph A. 
Published: February 2024

Abstract
Gastroesophageal reflux is the reflux of gastric contents other than air into or through the esophagus. Gastroesophageal reflux disease (GERD) refers to reflux that produces frequent symptoms or results in damage or dysfunction to the esophageal mucosa or contiguous organs of the upper aerodigestive system and occasionally the respiratory tract. Gastroesophageal reflux results from several factors that lead to symptoms or injury of the esophageal mucosa or the airway by reflux of corrosive material from the stomach.
Barrett Esophagus and Esophageal Cancer
Authors: Iyer Prasad G. , Vantanasiri Kornpong 
Published: February 2024

Abstract
Barrett esophagus is an acquired condition characterized by the replacement of the squamous epithelium lining the esophagus by partially intestinalized columnar epithelium. It is thought to be a complication of gastroesophageal reflux and may reflect an adaptive response to reflux of gastric contents into the esophagus. Squamous cell carcinoma and adenocarcinoma are the most common types of esophageal cancer. Esophageal carcinoma is the seventh leading cause of death in the world.
Nonvariceal Gastrointestinal Tract Bleeding
Authors: Bruining David H. , Alexander Jeffrey A. 
Published: February 2024

Abstract
Upper gastrointestinal (UGI) tract bleeding constitutes 75% to 80% of all cases of acute gastrointestinal tract bleeding. Although the incidence has decreased considerably, the mortality rate from acute UGI bleeding has decreased minimally in the past 50 years, ranging from 2.5% to 10%. This lack of change in the mortality rate likely is related to the older age of patients who present with UGI bleeding and the increase in associated comorbid conditions. Peptic ulcers re the most common source of UGI bleeding. Gastrointestinal tract bleeding has been classified according to the level of the tract: 1) upper—proximal to the ampulla of Vater; 2) mid—from the ampulla of Vater to the terminal ileum; and 3) lower—distal to the terminal ileum.
Gastrointestinal Manifestations of Systemic Disease
Authors: Sweetser Seth R. 
Published: February 2024

Abstract
Many systemic diseases can have gastrointestinal (GI) manifestations. Both the gut and the liver may be the main targets of the disease process, or they may be affected indirectly; in either case, the GI symptoms or signs may be the initial reason for seeking medical attention. This chapter is an overview of the more common systemic disorders that have well-recognized GI and liver manifestations, with an emphasis on disorders not considered elsewhere in this book.
Inflammatory Bowel Disease: Clinical Aspects
Authors: Chedid Victor G. , Coelho-Prabhu Nayantara 
Published: February 2024

Abstract
Inflammatory bowel disease (IBD) is a disease process characterized by chronic idiopathic intestinal inflammation along a spectrum that ranges from ulcerative colitis (UC) at one end to Crohn disease (CD) at the other. UC affects the colonic mucosa and extends proximally from the anal verge in an uninterrupted pattern that involves all or part of the colon. In contrast, CD is a transmural process that primarily affects the small bowel. However, CD can occur anywhere in the gastrointestinal tract from mouth to anus, manifesting as patchy inflammation with intervening areas of normal mucosa. Indeterminate colitis, now termed IBD colitis, unclassified type, in the middle of the spectrum, affects a small number of patients who have chronic colonic inflammation with features consistent with both UC and CD. All IBD, regardless of where it lies on the spectrum, can be associated with extraintestinal manifestations.
Nonalcoholic Fatty Liver Disease
Authors: Parthasarathy Gopanandan , Malhi Harmeet 
Published: February 2024

Abstract
Nonalcoholic fatty liver disease (NAFLD) refers to a spectrum of disorders defined by accumulation of fat in hepatocytes and includes isolated hepatic steatosis, also known as nonalcoholic fatty liver (NAFL), and nonalcoholic steatohepatitis (NASH), which is characterized by the presence of inflammation and hepatocyte injury (including ballooning), with or without fibrosis. NAFLD is the most common chronic liver disease in the Western world, affecting a quarter of the population. NAFL, defined by steatosis without inflammation, is generally benign, whereas NASH may progress to cirrhosis, liver failure, and hepatocellular carcinoma. Hence, distinguishing between NAFL and NASH has important prognostic and management implications.
A 77-Year-Old Man With Chronic Cough and Recurrent Pneumonia
Authors: Al-Ghoula Faysal K. , Aksamit Timothy R. 
Published: February 2024

Abstract
Bronchiectasis is a pathologic, irreversible dilatation of bronchi resulting from chronic damage to the bronchi (eg, from infection). Risk factors for bronchiectasis include cystic fibrosis, immune deficiency syndromes, chronic inflammatory lung disease, and chronic lung infections. Mycobacterium avium complex (MAC) is a common cause of bronchiectasis in the US. The diagnosis of either of the 2 types of MAC infection, cavitary and nodular-bronchiectatic, requires 2 sputum cultures positive for MAC or 1 bronchial washing culture positive for MAC. Treatment is with combination antibiotic therapy (azithromycin, rifampin, and ethambutol) that should be continued for at least 12 months after culture results are negative.
A 28-Year-Old Woman With Worsening Cough and Hemoptysis
Authors: Pfeifle Daniel O. , Chalmers Sarah J. 
Published: February 2024

Abstract
Cystic fibrosis (CF) is characterized by worsening lung function due to chronic inflammation and impaired mucociliary clearance. Symptoms include increased cough, increased sputum production, and dyspnea. Treatment includes hospital admission, IV antibiotics targeted to culture-specific microbes, long-term therapies with intensification of airway clearance therapies, and initiation of CF transmembrane conductance regulator modulator therapy. Hemoptysis can occur independently of CF, or it may indicate acute pulmonary exacerbation and can range from scant, which can be managed in the outpatient setting, to massive, which requires hospitalization. Bronchial artery embolization is first-line therapy for massive hemoptysis, particularly with hemodynamic instability.
A 51-Year-Old Man With Fever, Dyspnea, and Productive Cough
Authors: Herzog Tyler L. , Kelly Bryan T. , Kelm Diana J. 
Published: February 2024

Abstract
Pneumomediastinum and pneumoperitoneum are rare pulmonary disorders. They can occur spontaneously or result from medical treatment (iatrogenic causes), underlying disorders, or trauma. In patients receiving ventilation, pneumomediastinum and pneumoperitoneum result from barotrauma and alveolar rupture. Currently, no guidelines exist to guide evaluation and management of either disorder. Most patients present with mild, self-limited disease that resolves with conservative treatment. Administration of high concentrations of oxygen may help speed resorption of the free air. An underlying cause should be sought and treated as necessary. Rarely, patients may have a more serious complication, such as tension pneumomediastinum or abdominal compartment syndrome, that necessitates emergent treatment with decompression.
A 49-Year-Old Man With Massive Upper Gastrointestinal Tract Bleeding
Authors: Pennington Kelly M. , Wilson Michael E. 
Published: February 2024

Abstract
Inferior vena cava filters are indicated in patients with acute venothrombembolic disease and in patients with active bleeding or a high risk for bleeding. Complications associated with inferior vena cava filters are rare but can be associated with morbidity and mortality. Massive pulmonary embolism requires treatment with systemic or catheter-directed thrombolysis or mechanical clot evacuation.
A 63-Year-Old Woman With Back Pain, Weakness, Tachycardia, and Hypertension
Authors: Aragon Pinto Catarina N. , de Moraes Alice Gallo 
Published: February 2024

Abstract
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis. Attention should be given to neuromuscular respiratory failure and arrhythmias. Regular measurement of respiratory pressures and forced vital capacity and continuous cardiac monitoring are lifesaving for patients with Guillain-Barré syndrome. Intravenous immunoglobulin and plasma exchange are the currently available immunotherapies. However, pharmacologic treatment does not improve survival, and supportive therapy is extremely important in the care of these patients.
A 60-Year-Old Man With Persistent Coma
Authors: Subat Yosuf W. , DuBrock Hilary M. 
Published: February 2024

Abstract
The classic presentation of patients with Miller Fisher syndrome (MFS) is the triad of ataxia, ophthalmoplegia, and areflexia. MFS most often occurs after an antecedent illness most likely caused by an autoimmune process involving molecular mimicry. The diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP) is supported by a cerebrospinal fluid profile that shows an albuminocytologic dissociation and electromyographic findings that show demyelination. Serum anti-GQ1b antibody levels are increased in nearly 90% of patients with MFS. AIDP is often self-limited, but treatment with intravenous immunoglobulin or plasma exchange can shorten the recovery time.
An 83-Year-Old Woman With Obstructive Sleep Apnea at High Altitude
Authors: Dupuy-McCauley Kara L. , Selim Bernardo J. 
Published: February 2024

Abstract
Sleep-disordered breathing can worsen at high altitude because of increased frequency of centrally mediated disordered breathing events and subsequent increased arousal from sleep with changes in sleep architecture. Consequences may include worse blood pressure control, decreased daytime alertness, and sleep fragmentation (insomnia). Before travel to high altitude, patients should be counseled about the potential for worsening of obstructive sleep apnea and the emergence of high-altitude periodic breathing from central sleep apnea. If descent from high altitude is not feasible, a change in CPAP or APAP pressure settings with or without either supplemental oxygen or acetazolamide should be considered.
A 71-Year-Old Woman With Diarrhea and Recurrent Fever
Authors: Sangli Swathi S. , O’Horo John C. , Scanlon Paul D. 
Published: February 2024

Abstract
Histoplasmosis is an important complication in patients receiving TNF-α inhibitors, especially infliximab. If patients have risk factors such as an immunosuppressed state, certain infections, or rheumatologic disease, a high degree of awareness for secondary hemophagocytic lymphohistiocytosis is essential to secure the diagnosis. Prompt treatment of the underlying cause is critical for the resolution of hemophagocytic lymphohistiocytosis.
A 54-Year-Old Woman With Chronic Hoarseness and Cough
Authors: Chalmers Sarah J. , Thomas Charles F. 
Published: February 2024

Abstract
Small cell lung cancer (SCLC) accounts for approximately 15% of all lung cancers and most commonly presents as a medially located pulmonary mass with associated mediastinal and hilar lymphadenopathy. SCLC is characterized by its rapidly progressive nature and often presents with widely metastatic disease. Diagnosis and staging should be made by the least invasive method. If results from initial diagnostic evaluations are negative and clinical suspicion is high, further tissue diagnosis should be pursued. Treatment of SCLC consists of chemotherapy, which is often given with radiotherapy and prophylactic cranial radiotherapy. Reoccurrence is common.
A 49-Year-Old Woman With Coital Hemoptysis
Authors: Piccolo Serafim Laura , Clay Ryan D. , Utz James P. 
Published: February 2024

Abstract
Coital hemoptysis is rare, but when it is present, a cardiac cause should be assumed until proved otherwise. Cardiac amyloidosis has a nonspecific presentation and should be part of the differential diagnosis when a patient has heart failure with preserved ejection fraction. Cardiac amyloidosis is frequently present in patients who have systemic AL amyloidosis. Management involves treating the heart failure with diuretics and identifying and treating the underlying cause of the amyloid deposition.
A 64-Year-Old Man With Back Spasms and Dyspnea 3 Weeks After Lung Transplant
Authors: Lau Jessica 
Published: February 2024

Abstract
Lung transplant is an effective option in the treatment of end-stage lung disease, but pulmonary complications can arise after transplant and lead to serious morbidity and death. The present case highlights the importance of recognizing the more subtle complications of transplant such as airway complications. Pulmonary complications do not occur in isolation, though, so it is important to recognize that in the patient described above, the presence of empyema and the later development of a pneumothorax may have been signs of anastomotic complications.
A 23-Year-Old Man With Dyspnea and Pleural Effusions
Authors: Felzer Jamie R. , Egan Ashley M. 
Published: February 2024

Abstract
Malignant mesothelioma is a rare disease that is more common in older male patients who have been exposed to asbestos, but it can occur in younger patients without asbestos exposure. Symptoms are nonspecific and may include fever, weight loss, pain, and lymphadenopathy. Diagnosis should be made from biopsy of the mass. The prognosis is poor overall, but surgery and chemotherapy are options.
A 68-Year-Old Man With Chronic Cough
Authors: Duke Jennifer D. , Long Cameron M. 
Published: February 2024

Abstract
Occupational pneumoconiosis is a reaction of the lung to inhalation and subsequent deposition of inorganic particles and dust. Silicosis is caused by the inhalation of silicon dioxide, which can lead to lung inflammation and fibrosis across a spectrum of severity. No proven treatment exists for silicosis, and lung transplant may be required.