Hal 53

CARDIOVASCULAR SYSTEM
Nuclear medicine imaging and data processing tehniques provide accurate , repeatable evaluation of
cardiac structure , perfusion , and function. These approaches have application in patients with
coronary artery disease , congenital and valvular heart disease , and cardiomyopathy.
CARDIAC BLOOD POOL IMAGING AND EVALUATION OF VENTRIKULAR FUNCTION
Radioisotopic imaging of the cardiac blood pool is performed after intravenous ( i.v .) injection of a
radiopharmaceuticals, such as
99 m
Tc labeled red cells , which remains in the intravascular space.
In vivo , in vitro and in vitro tehniques for labelling red cells are used .
Gated images of the labeled cardiac blood pool ( MUGA study ) evaluate left ventricular function and
regional ventricular wall motion. These images are obtained by gating , or triggering , the scintillation
cameras count acquisitions to the electrocardiogram ( ECG ) signal. Images of the heart in systole
and diastole are created by summing counts obtained during end systole and end diastole over
many cardiac cycles . images of other short intervals throughout the cardiac cycle may be obtained
as well. The cardiac cycle can be subdivided into 16 64 frames ; counts for each frame are
accumulated from many heart beats to form the multiple images of a composite heart beat .
Hal : 54
this collection of counts requires a stable, regular rhythm . in patients with arrhythmias , the use of
computer programs designed to climinate bad beats is necessary . the resulting iamges from
each portion of the cardiac cycle can be viewed individually or more importantly , can be displayed
in cinematic fashion on the compuperception of regional wall motion abnormalities is greatly
improved by this cinematic display format . in the left anterior oblique projection the left ventricle
can be visualized without overlap from the other cardiac chambers ( Fig . 4 1 A ) . the counts
detected in the left ventricle are proportional to volume , and the change from end systolic counts
( ESC ) to end diastolic counts ( EDC ) of the left ventricle can be used for the calculation of left
ventricular ejection fraction from yhe formula :
Ejection fraction =
The left ventricular ejection fraction is a sensitive indicator of left ventricular dysfunction . the
ejection fraction is normally > 50 % ; however , patients with recent myocardial infarction show
decrease in ejection fraction that is closely correlated with the volume of infarcted myocardium, as
well as with prognosis.
Serial measurements of left ventricular ejection fraction are likely to assume increasing importance
in the management of patients with myocardial infarction as more vigorous therapeutic
interventions designed to protect ischemic myocardium are employed in these patients . under
these circumstances, ejection fraction measurements can be helpful in determining whether a
patients is suitable for a particular type of intervention . these measurements may also be used to
indicate whether therapy is significantly improving or adversely affecting left ventricular
performance . this application has been greatly facilitated by the development of mobile scintillation
cameras and computers. Thus, gated cardiac imaging , as well as many other nuclear medicine
studies , may be performed at the bedside of critically ill patients in intensive care units .


Hal. 55
Gambar
FIG . 4 1 ( A) Normal patients : left anterior oblique views of end diastole and end systole
obtained using
99m
Tc labeled autologous red blood cells show good wall motion of the left
ventricle ( arrows ) . in this view , the interventricular septum is seen clearly as a region of decreased
counts between the left ventricle and the right ventricle. The lower left panel shows computer
printout of ejection fraction , 62% in this normal patient and the volume curve of left ventricular
counts versus time for aa composite r to r interval ( cardiac cycle ) . the lower right panel shows
the contours of end diastole ( outer circle ) and end systole ( inner circle ) superimposed . good
wall motion between diastole and systole is seen . the high septal region , corresponding to numbers
14 19 on the wall motion display , is a region of valve planes and therefore cannot be analyzed for
wall motion .
TRANSLATE
Hal. 53
Sistem Kardiovaskular
Pencitraan dokter nuklir dan teknik pengolahan data memberikan informasi yg akurat berupa
evaluasi terulang tentang struktur jantung , perfusi dan fungsinya. Pendekatan ini memiliki aplikasi
pada pasien dengan penyakit arteri koroner ,penyakit jantung bawaan dan kardiomiopati.
Pusat darah jantung dan evaluasi fungsi ventrikel
Gambaran radioisotop dari pusat darah jantung dilakukan setelah injeksi intravena dari radiofarmasi
seperti
99m
Tc berlabel sel darah merah , yang tetap berada dalam ruang intravaskular. In vivo , in
vivtro dan in vitro termasuk teknik untuk pelabelan sel darah merah yang digunakan .
Gambaran cara masuk dari berlabel pusat darah jantung ( MUGA study ) yang mengevaluasi fungsi
ventrikel kiri dan gerakan dinding ventrikel regional . gambar gambar ini diperoleh dengan gating
atau pusat pemicu ,akuisisi hitungan cahaya kamera ke sinyal elektrokardiogram ( ECG ) . gambar
jantung pada sistol dan disistol diperoleh dengan menjumlahkan hasil yang diperoleh selama akhir
sistol dan akhir disistol lebih banyak siklus jantung . gambar interval pendek lainnya sepanjang siklus
jantung diperoleh sebagai siklus dinding jantung . perputaran jantung dapat dibagi menjadi 16 64
kerangka ; dihitung untuk setiap kerangka diakumulasi dari banyak denyut jantung untuk
membentuk beberapa gambar dari susunan jantung berdetak .
Hal . 54
Peerhitungan ini dari jumlah yang stabil, irama teratur .pada pasien dengan aritmia , penggunaan
program komputer yang dirancang untuk keperluan detak yang bergejolak buruk . gambar yang
dihasilkan dari setiap bagian siklus jantung dapat dilihat yang lebih penting secara individual , dapat
dilihat dalam mode sinematik pada tampilan video komputer sebagai gambaran irama detak jantung
. persepsi kelainan gerakan dinding regional sangat ditingkatkan dengan format layar sinematik. Di
sebelah kiri proyeksi anterior , ventrikel kiri dapat di visualisasikan tanpa tumpang tindih dari ruang
jantung lainnya . dalam perhitungan , terdeteksi dalam ventrikel kiri sebanding dengan volume dan
perubahan dari jumlah akhir sistolik ( ESC ) jumlah untuk mengakhiri distolik ( EDC ) dari ventrikel kiri
dapat digunakan untuk perhitungan fraksi ejeksi ventrikel kiri dari rumus :
Fraksi ejeksi =
Fraksi ejeksi ventrikel kiri merupakan indikator yang sensitif dari disfungsi ventrikel kiri . fraksi ejeksi
biasanya > 50 % . namun pasien dengan infark miokard menunjukkan penurunan fraksi ejeksi yang
erat hubungannya dengan volume infark miokardium , serta dengan prognosis.