bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measurement of Myocardial Blood Flow by SPECT
Authors: Brito Juliana Brenande de Oliveira , Small Gary R. , Ascah Kathryn J. , Wells R. Glenn , Ruddy Terrence D. 
Published: February 2024

Abstract
Stress MPI with SPECT and PET is widely used for diagnosis and determining prognosis in patients with suspected or known CAD. However, a major limitation of MPI is the use of relative perfusion for diagnosis of obstructive CAD and leads to underestimation of the extent of obstructive CAD. However, MBF and MFR can be measured with PET and provide additional diagnostic and prognostic value over relative PET MPI. Similarly, SPECT measurement of MBF may improve the clinical value of SPECT and greatly increase the availability and use of MBF with MPI. The accuracy of CZT SPECT measurement of MBF has been validated in clinical evaluations in patients undergoing coronary angiography and PET imaging. Reduced global stress MBF and MFR can identify the presence of severe MVD. Regional reductions in stress MBF and MFR have high diagnostic accuracy for specific vessel CAD. Reduced global and regional SPECT MFR can predict reduced global and regional PET MFR. SPECT measurement of MBF has good day-to-day repeatability and interobserver variability. We describe the use of SPECT MBF at the University of Ottawa Heart Institute, including image acquisition and processing and clinical interpretation of test results with case examples. The clinical use of SPECT MBF is in the early stages of implementation. Protocols including radiotracers, camera systems and software need to be standardized. Multicenter studies are necessary to better define the diagnostic value of CZT SPECT MBF for obstructive CAD and the incremental prognostic value of SPECT MBF measurement compared to relative MPI.
Imaging Myocardial Innervation by SPECT and PET
Authors: Travin Mark I. 
Published: February 2024

Abstract
Nuclear cardiology, able to directly assess underlying pathophysiology, is uniquely advantageous for assessing cardiac autonomic innervation that plays a crucial role in proper cardiovascular function. Cardiac disease disrupts this innervation, contributing to and being a marker for disease severity and worsened patient outcome. Sympathetic and parasympathetic components can be imaged with radiotracers, with current clinical applications limited to analogs of the sympathetic mediator norepinephrine, mostly with the adrenergic SPECT tracer iodine-123 metaiodobenzylguanidine (123I-mIBG) and the PET tracer 11C-hydroxyephedrine. Sympathetic innervation image analysis involves determining global cardiac radiotracer uptake and retention on planar displays, and regional uptake patterns on tomography. Image findings consistently demonstrate ability to risk stratify patients with advanced heart failure and associated potentially lethal ventricular arrhythmias independently of, and often better than, conventional clinical, ECG, serum, and imaging modalities, in particular able to identify extremely low short-term risk subgroups. Cardiac innervation imaging has potential to better guide use of invasive, costly electronic devices, especially improved selection of patients for an implantable cardioverter defibrillator. Such clinical implementation of innervation imaging has been hampered by lack of the randomized clinical trials required for acceptance. There are promising studies using innervation imaging to guide ventricular and atrial arrhythmia ablation. Given the ubiquitous role of innervation in cardiovascular processes, innervation imaging also shows promise for evaluating coronary disease risk, following heart transplant patients, detecting dangers from diabetes, and monitoring deleterious chemotherapy effect. The technique can be advanced through improved imaging hardware and analysis software, and development of new, especially PET, radiotracers.
Physician Certification and Laboratory Accreditation
Authors: Hendel Robert C. , Park Minnsun K. , Sidhu Gursukhmandeep S. 
Published: February 2024

Abstract
Physician certification and laboratory accreditation are two major components of quality assurance and the optimal performance of a nuclear cardiology program. Physician certification is a process by which a physician receives professional recognition for having achieved the necessary knowledge, skills, and experience in a specific field. Different pathways for certification are available, often based on prerequisites depending on the candidate’s training background, experience, and location of training. Laboratory accreditation is an analytical process that provides stringent national standards to ensure a high level of quality, hopefully with a direct impact on patient care. The process may usually be completed in 3 to 6 months and is valid for up to 3 years. Accreditation may be done via national CMS-certified agencies, each with individual established rigorous criteria. Accreditation is an independent peer-review process with the objective of overall improvement in the quality of the nuclear laboratory. Accreditation is an ongoing effort striving for uninterrupted value to confirm adherence to high-quality care.
Radiation Considerations in Imaging
Authors: Einstein Andrew J. 
Published: February 2024

Abstract
As a group of procedures involving exposure of patients and providers to ionizing radiation, nuclear cardiac imaging studies should adhere to the fundamental principles of radiological protection: justification, optimization, and dose limitation. Justification refers to ensuring that the right test is performed for the right patient at the right time, and is aided by Appropriate Use Criteria developed by professional societies. Optimization, often framed in terms of the as low as reasonably achievable (ALARA) principle, refers to ensuring that the test is performed in the right manner while ensuring diagnostic image quality. There are a variety of approaches to optimization in nuclear cardiac imaging, including utilizing stress-first/stress-only 99mTc protocols, selecting administered activities reflecting a patient’s habitus, avoiding protocols incorporating 201Tl as a perfusion tracer, and using technological advances in software and hardware instrumentation, such as positron emission tomography or solid-state cameras, which permit reduced radiation dose from radiopharmaceuticals without loss of image quality. Dose limitation is not applicable in the context of radiologic protection of patients, but dose limits for health care workers and the general public remain important aspects of radiological protection. This chapter addresses a variety of radiation-related considerations in nuclear cardiac imaging, reflecting each of these principles of protection.
Measurement of Myocardial Blood Flow by PET
Authors: Schelbert Heinrich R. 
Published: February 2024

Abstract
MBF measurements of MBF with PET have now become widely available for clinical use. Such measurements expand the scope of MPI for the detection of obstructive coronary artery disease; they offer noninvasive assessment of functional consequences of flow-limiting disease of the epicardial conduit vessels but also of functional or structural alterations of the microvascular circulation. Besides O-15 water and N-13 ammonia, Rb-82, supplied ready for use with a clinically practical generator system, has become the most widely used flow tracer. Fundamental to flow measurements is knowledge of the tissue tracer kinetics of the radiotracer and their description by a tracer compartment model, that, when applied to the arterial radiotracer input function and the myocardial radiotracer uptake response to it, both captured from serially acquired PET images, yield quantitative estimates of global and regional MBF. Noninvasive estimates of flow have been validated against microsphere-measured flows. Commercial software packages facilitated the clinical use of PET MBF measurements; they re-sort and process the dynamically acquired image data and report values of rest and hyperemic stress flows and of the myocardial flow reserves in quantitative units. Highly automated, they reduce intra- and inter-observer as well as test-retest variabilities. Yet, estimates of MBF and, of myocardial flow reserves differ between software packages, with additional variabilities imposed by type of radiotracer and the imaging device with specific image-reconstruction algorithms. Harmonization across imaging platforms will therefore be essential for flow estimates to become comparable across institutions and for widespread use and acceptance.
Myocardial Viability Assessment by Nuclear Techniques
Authors: Dilsizian Vasken , Valenta Ines , Schindler Thomas H. 
Published: February 2024

Abstract
Viability assessment with cardiac FDG-PET/CT is commonly applied in ischemic cardiomyopathy patients with an LVEF of 35% or less and pronounced segmental wall-motion disturbances (severe hypokinesis to akinesis, or dyskinesis). The combined application of rest perfusion imaging and FDG-PET/CT may unmask “match” findings between perfusion and viability assessment, indicative of transmural necrosis or non-transmural necrosis and no ischemic component, and “mismatch” findings, denoting non-transmural necrosis with viable but ischemic, compromised myocardium, or completely viable and ischemic, and compromised myocardium. In about 20% to 40% of these patients, FDG-PET/CT is likely to detect a sufficient amount of viable myocardium, unmasking viable but ischemic, compromised myocardium. Cardiomyopathy patients with mismatch-defined hibernating-stunned myocardium in dysfunctional wall segments, if large enough (at least four segments), who undergo coronary revascularization are likely to benefit in terms of both recovery of LV function and clinical outcome. However, no such benefit is commonly observed for those with “match” findings, and optimized medical heart failure treatment may be preferred. Predominantly viable but ischemic, compromised myocardium may have a positive predictive value of up to 74% for functional recovery after coronary revascularization. Thus, in about 16% of patients with classical “mismatch” findings, the restoration of coronary flow may not translate into recovery of LV function due to an advanced remodeling process with interstitial fibrosis and structural disintegration of cardiomyocytes, whereas improvement in clinical outcome may still ensue.
Artificial Intelligence and Nuclear Imaging
Authors: Miller Robert J. H. , Slomka Piotr J. 
Published: February 2024

Abstract
Artificial intelligence (AI) has become an increasingly important tool, with rapidly expanding implications for use in the field of nuclear cardiology. In this chapter the authors first review common terminology used in AI, including the differences between deep learning and classical machine learning. The potential role for AI to improve image processing or image segmentation is discussed, followed by the potential clinical role for AI in assisting with image reporting and the evidence for the use of AI to improve the diagnosis of disease or to predict risk. The authors conclude the chapter by reviewing potential clinical applications of AI and methods to improve its implementation.
The Role of Nuclear Cardiology in the Management of Cardiovascular Diseases in Patients Living with HIV
Authors: Aljizeeri Ahmed , Al-Mallah Mouaz H. 
Published: February 2024

Abstract
The introduction of highly active retroviral therapy in the last decade of the 20th century has changed the natural history of HIV infection. HIV evolved from an acute infectious process to a chronic stable condition with improved survival. With near-normal life expectancy, people living with HIV have a higher risk of cardiovascular diseases due to aging and an increased prevalence of traditional risk factors in addition to other factors associated with HIV infection and antiretroviral therapy. Nuclear cardiology is one of the cornerstones of the evaluation and management of a broad spectrum of cardiovascular diseases. This chapter summarizes the role of nuclear cardiology in the initial evaluation and management of cardiovascular diseases in people living with HIV.
Nuclear Imaging in Cardio-Oncology
Authors: Harinstein Matthew E. , Russell Raymond 
Published: February 2024

Abstract
Chemotherapeutic agents can cause a variety of cardiovascular toxicities that are unique to the specific drug that is being used to treat a cancer. The field of cardio-oncology focuses on recognizing those toxicities and utilizing noninvasive imaging as well as biomarkers to predict the risk of cardiotoxicity and to prevent or mitigate that toxicity. Nuclear cardiac imaging plays an important role in the prevention and detection of cardiotoxicity, during, immediately after, and years after cancer treatment, not only for well-characterized agents such as anthracyclines and trastuzumab but also for the newer molecularly targeted chemotherapeutic agents. This chapter reviews the important role of nuclear cardiac imaging in the management of patients with cancer.
Radionuclide Imaging in Patients with Congenital Heart Diseases
Authors: Partington Sara L. , Dorbala Sharmila 
Published: February 2024

Abstract
Patients with congenital heart disease (CHD) are at risk for myocardial ischemia due to coronary abnormalities from their CHD, atherosclerotic coronary artery disease, and iatrogenic complications from procedures and surgeries. Radionuclide imaging with SPECT or PET has a key role in evaluating cardiovascular diseases in adults and is emerging as an invaluable tool in select patients with CHD to assess for ischemia. Appreciating the physiologic state, congenital heart anatomy, and proposed mechanism of ischemia prior to initiating a stress radionuclide study ensures that the stress component of the study can be performed safely and effectively with acquisition of appropriate physiologic information. Understanding the CHD anatomy ensures that there is accurate interpretation of the myocardial perfusion imaging, particularly that the perfusion of the appropriate ventricle is assessed and patch and prosthetic material are taken into account. Nuclear medicine can also assess for device infections and pulmonary artery flow, frequent concerns in CHD. Planning the study to allow for the lowest possible radiation dose enhances the safety of studies in patients with CHD and allows for radionuclide imaging to be a safe and effective tool in assessing patients with CHD.
Gastrointestinal Motility Disorders,
Authors: Wang Xiao Jing (Iris) 
Published: February 2024

Abstract
Motility disorders result from impaired control of the neuromuscular apparatus of the gut. Symptoms vary according to which portion of the gastrointestinal tract is affected. Motility disorders specifically affecting the esophagus and colon are addressed in other chapters of this book and can lead to symptoms such as dysphagia (ineffective esophageal peristalsis, achalasia) or constipation (slow transit constipation). Gastroparesis, which affects the stomach, and intestinal pseudo-obstruction, which affects the small intestine and colon, are motility disorders that can cause symptoms of recurrent or chronic nausea, vomiting, bloating and abdominal discomfort, constipation, or diarrhea, all of which occur in the absence of a structural lesion.
Clinical Features of Malabsorptive Disorders, Small-Bowel Diseases, and Bacterial Overgrowth Syndromes
Authors: Oxentenko Amy S. 
Published: February 2024

Abstract
Both malabsorption (a defect in the mucosal absorption of nutrients) and maldigestion (a defect in the hydrolysis of nutrients) imply disordered physiologic mechanisms in the gastrointestinal system. Malabsorption and maldigestion of nutritional substrates can occur in multiple phases: 1) the luminal phase, in which there is contact between ingested food and various digestive enzymes; 2) the mucosal phase, in which substances are assimilated and absorbed in the required constituent form; and 3) the delivery phase, in which nutrients are taken up into the cytoplasm and transported to the lymphatics or portal venous system.
Nutritional Disorders: Vitamins and Minerals
Authors: Arora Amindra S. 
Published: February 2024

Abstract
Vitamins and minerals are critical for normal health because they are essential in a vast assortment of metabolic functions. This chapter focuses on selected important vitamins and minerals and their relationships with gastrointestinal tract disorders. Iron deficiency can result in microcytic hypochromic anemia, altered immune function, angular stomatitis, koilonychia, and atrophic lingual papillae. Causes of iron deficiency include lack of dietary iron, increased gastrointestinal loss of iron (bleeding), poor absorption of iron (celiac disease), surgical procedures that bypass the duodenum, achlorhydria, and Helicobacter pylori infection.
Vascular Disorders of the Gastrointestinal Tract
Authors: Sweetser Seth R. 
Published: February 2024

Abstract
Mesenteric ischemia (MI) includes several clinical conditions that occur when splanchnic blood flow is inadequate and thus fails to meet the metabolic demands of the intestines. The condition can result in symptomatic and life-threatening clinical presentations. The incidence of MI is increasing because of the aging population, increasing number of critically ill patients, and heightened clinical awareness. MI produces a spectrum of disorders that depend on many factors, including the acuity of the event, the vessel involved, and the length of bowel affected. In general, MI can be divided into 4 clinical syndromes: acute mesenteric ischemia, chronic mesenteric ischemia, colonic ischemia, and focal segmental ischemia. These 4 syndromes account for most manifestations of ischemic injury to the gut. This chapter reviews the epidemiology, pathophysiology, clinical presentation, and management of these conditions and discusses other vascular syndromes of the gastrointestinal tract.
Irritable Bowel Syndrome
Authors: Vijayvargiya Priya , Prichard David O. 
Published: February 2024

Abstract
Irritable bowel syndrome (IBS) is characterized by abdominal pain and altered bowel habits in the absence of detectable biochemical or structural abnormalities. The goal of therapy is to improve the patient’s symptoms, prevent suffering, and improve quality of life. Altered bowel habits and abdominal pain may need to be treated independently. The bidirectional relationship between gastrointestinal symptoms and psychological issues is well established, and behavioral therapies are effective. The diagnosis of IBS is symptom based. Routine serologic screening for celiac disease in patients with IBS is recommended. Initial treatment involves lifestyle and dietary modifications with symptomatic remedies. Patients with persistent gastrointestinal symptoms despite these initial measures should undergo tests to identify causative factors.
Viral Hepatitis,
Authors: Leise Michael D. 
Published: February 2024

Abstract
Viral infections are important causes of liver disease worldwide. The 5 primary hepatitis viruses that have been identified are A, B, C, D (or delta), and E. Other viruses, such as cytomegalovirus and Epstein-Barr virus, also can result in hepatitis as part of a systemic infection. In addition, medications, toxins, autoimmune hepatitis, or Wilson disease may cause acute or chronic hepatitis. It is useful to divide hepatitis syndromes into acute and chronic forms. Acute hepatitis can last from a few weeks to 6 months and is often accompanied by jaundice. Symptoms of acute hepatitis tend to be similar regardless of cause and include anorexia, malaise, dark urine, fever, and mild abdominal pain. In chronic hepatitis, patients are often asymptomatic but may complain of fatigue.
Alcohol-Related Liver Disease
Authors: Huebert Robert C. , Shah Vijay H. 
Published: February 2024

Abstract
Alcoholic liver disease is a major cause of morbidity and mortality worldwide. Globally, approximately 2 billion people consume alcohol, and alcohol use disorder is diagnosed in more than 75 million people—and these numbers are probably underestimates. In the US, chronic liver disease is the 12th leading cause of death, and alcohol is implicated in approximately 50% of these deaths. Also, alcoholic liver disease is a major source of health care expenditures, accounting for nearly $5 billion annually. Alcohol-related liver disease is the leading indication for liver transplant in the US. Recent increases in deaths due to alcohol-related liver disease are skewed toward younger age groups (25-34 years), and deaths due to alcohol-related liver disease are projected to increase in the coming years, particularly among women.
Vascular Diseases of the Liver
Authors: Kulai Tasha B. , Sanchez William 
Published: February 2024

Abstract
Vascular diseases of the liver can be divided into disorders of hepatic inflow (ie, disorders of portal venous inflow and disorders of hepatic arterial inflow) and disorders of hepatic venous outflow. For a better understanding of the vascular diseases of the liver, a concise review of the vascular anatomy of the liver is important. The splanchnic circulation comprises the arterial blood supply and venous drainage of the entire gastrointestinal tract from the distal esophagus to the midrectum and includes the spleen (which is why splenomegaly and thrombocytopenia develop in the presence of portal hypertension), pancreas, gallbladder, and liver.
Acute Pancreatitis
Authors: Maselli Daniel B. , Chandrasekhara Vinay 
Published: February 2024

Abstract
Acute pancreatitis is an inflammatory condition characterized by severe abdominal pain and both locoregional and systemic inflammatory complications. More than 200,000 new cases of acute pancreatitis occur in the US each year, and the incidence is increasing. The disease is severe in 20% of patients with acute pancreatitis, and approximately 5% of all patients with pancreatitis die of the disease. Hence, key management principles include prompt diagnosis, triage of patients with severe pancreatitis to aggressive care, and identification of the underlying cause to prevent recurrence. Necrotizing pancreatitis accounts for most of the morbidity and nearly all the mortality associated with acute pancreatitis.
Chronic Pancreatitis
Authors: Janssens Laurens P. , Majumder Shounak 
Published: February 2024

Abstract
Chronic pancreatitis is an inflammatory condition of the pancreas characterized by progressive fibrosis that leads to irreversible destruction of exocrine and endocrine tissue, resulting eventually in exocrine and endocrine insufficiency. There is considerable heterogeneity in the manifestation and natural history of the condition. Chronic pancreatitis is classified broadly into chronic calcifying pancreatitis, chronic obstructive pancreatitis, and chronic autoimmune pancreatitis. Chronic calcifying pancreatitis is usually characterized by recurrent bouts of clinically acute pancreatitis early in the course of the disease and development of intraductal stones later in the disease course. Steatorrhea and diabetes mellitus eventually develop in most patients. This is the clinical profile of the disease that readily comes to mind when the term chronic pancreatitis is used in clinical practice.
Pancreatic Neoplasms
Authors: De La Fuente Jaime , Majumder Shounak 
Published: February 2024

Abstract
Pancreatic ductal adenocarcinoma (PDAC), sometimes referred to as pancreatic cancer, is a leading cause of cancer death in the US. In 2021 in the US, an estimated 60,430 new cases of PDAC occurred, and 48,220 people died of the disease. Although only 3.2% of new cancer diagnoses in the US were PDAC, it accounts for 7.9% of all cancer deaths. The worldwide trend shows increasing PDAC incidence and mortality. Survival has improved in recent years, but the overall 5-year survival is only about 11%; it is nearly 50% among persons with a diagnosis of localized disease. Less than 20% of patients are candidates for surgical resection, and more than 50% have metastatic disease at the time of diagnosis. In the US, the lifetime risk for PDAC is approximately 1.6%, and the risk increases with age.