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Assessment of Cardiac Function: First-Pass, Equilibrium Blood Pool, and Gated Myocardial SPECT

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Atlas of Nuclear Cardiology

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Abstract

Radionuclide-based techniques have been used to measure ventricular function for over three decades [1–8]. The methods for measurement of ventricular function can be divided into two basic categories. The first category employs any tracer that can directly label the blood pool itself. One then examines the deformity of the cavitary blood pool as it is moved by the thickening and systolic motion of the myocardial walls. With these methods, one can directly image the blood pool in the ventricular cavity throughout the cardiac cycle. The second category of methods for measurement of ventricular function uses tracers that label the myocardial walls (e.g., 99mTc-sestamibi, [18F]-fluorodeoxyglucose). One then examines how those walls thicken and translate, move, or contract throughout the cardiac cycle. With this method, one can directly image the myocardium throughout the cardiac cycle. Active movement or contraction of the inner endocardial wall of the ventricular chamber compresses the blood pool and deforms the ventricular cavity and is the conventional marker for systolic ventricular wall motion or function. Only this method permits the evaluation of myocardial wall thickening, a marker of systolic function and viability that can help separate passive systolic wall motion from active myocardial contraction. This method for measuring ventricular mechanical function simultaneously yields a measurement of myocardial perfusion or of metabolism (depending on the tracer used to label the myocardium), but this advantage is also a source of one of the method’s disadvantages: If perfusion or metabolism is reduced in a particular segment of the myocardium, then that segment is not easily visualized, hampering visualization of wall motion or thickening in that segment. Temporal and spatial resolution of the related functional image data is not as good as for the blood pool method.

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Authors and Affiliations

  1. University of California San Francisco School of Medicine, San Francisco, CA, USA

    Elias H. Botvinick & J. William O’Connell

  2. Department of Radiology, University of California San Francisco School of Medicine, San Francisco, CA, USA

    Nick G. Costouros

  3. Department of Radiology, Center for Molecular and Functional Imaging, University of California San Francisco School of Medicine, San Francisco, CA, USA

    Stephen L. Bacharach

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  1. Elias H. Botvinick
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  1. University of Maryland School of Medicine, Baltimore, MD, USA

    Vasken Dilsizian

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jagat Narula

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Botvinick, E.H., Costouros, N.G., Bacharach, S.L., O’Connell, J.W. (2021). Assessment of Cardiac Function: First-Pass, Equilibrium Blood Pool, and Gated Myocardial SPECT. In: Dilsizian, V., Narula, J. (eds) Atlas of Nuclear Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-49885-6_7

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