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Cardiovascular Imaging
1st Faculty of Medicine, Charles University in Prague Center for Advanced Preclinical Imaging (CAPI)
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI)
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Cardiovascular ImagingCardio and Vascular Imaging
• Vascularization / Angiogenesis
• Cardiovascular Imaging
metabolic imaging of the heart
myocardial perfusion imaging
Cardiac CT
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Vascularization / Angiogenesis
• Vascularization / Angiogenesis
Developmental Angiogenesis
Tumor Angiogenesis
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Developmental Angiogenesis
• Misclassification of vascular anomalies remains common despite
fundamental pathologic differences
• An accurate distinction is important for management:
– Though most hemangiomas spontaneously resolve,
approximately 10-20% will warrant pharmacologic, surgical, or
laser intervention
– Percutaneous sclerotherapy or more invasive transarterial
embolization is used to treat vascular malformations depending
on whether the lesion is high-flow or low-flow
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Vascular Anomaly Diagnosis
• Most often a clinical
diagnosis
• Radiologic imaging provides
a role in challenging cases
and can be used to assess
the depth and extent of the
lesion
– Ultrasound: provides
excellent characterization
of superficial structures and
hemodynamics
– MRI: single best exam due
to its strong soft tissue
contrast and ability to
define extent of the lesion
and involvement with
nearby structures
http://www.adhb.govt.nz/newborn/teachingresources/dermatology/VascularLesions.htm
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Hemangioma2 year old female – left gluteal hemangioma
Spectral color doppler US image demonstrates a
well-defined heterogenous mass with arterial
waveform Sagittal T1W with fat saturation post
contrast MR image demonstrates avid and
homogenous enhancement of the mass
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Arteriovenous Malformation12 week old female – right scapular AVM
Spectral color Doppler US image demonstrates a
waveform typical for low arterial resistance with
arterialization of the draining veins Coronal T1 with fat saturation post contrast MR
image demonstrate avid enhancement of the
lesion
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Tumor Angiogenesis
Molecular imaging of the αvβ3 integrin:
A - SPECT
B - PET
C - optical imaging
D - MRI
E - xenograft tumor after injection of microbubbles conjugated with ariginine-glycine-aspartic acid (RGD)
F - xenograft tumor after injection of microbubbles conjugated with scrambled control peptide
G - presence of single microbubbles after injection of αvβ3-targeted microbubbles
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Tumor AngiogenesisDynamic contrast enhanced MRI (DCE_MRI)
• Technique where enhancement of a tissue or organ is continuously monitored using MRI after bolus IV contrast medium
– Low molecular weight contrast media (<1 kDa)
– Diffuse into extravascular-extracellular space (does not cross cell membranes)
– Experiment lasts a few minutesDavid Collins and Ian Judson, Institute of cancer Research, London
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Basics of DCE-MRI
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Basics of DCE-MRIT2*W DCE-MRI of Mixed Mullerian Tumour
Typical acquisition 1-2 mins
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Cardiovascular ImagingMyocardial Perfusion
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial Perfusion
• Schematic representation of interpretation of myocardial perfusion
images
• Shaded areas indicate myocardial perfusion defects
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial Perfusion
• Summed images are used to assess cardiac perfusion. Rest and Stress
images are compared to determine if a region of the heart is “ischemic” –
starved of oxygen
• In the study below, the rest image indicates normal blood flow, but the stress
image indicates abnormal blood flow in the Inferior-lateral region.
• This may indicate “ischemia” in this region of the heart – which is supplied by
the LCX (left circumflex artery). There may be stenosis in that coronary artery.
Stress
Rest
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
• Gated images are made
possible by ECG-gated
SPECT
• Physicians can now
access cardiac function:
• Wall motion – does the
LV contract uniformly?
• Ejection Fraction – does
the LV pump out enough
blood to the body?
SA
HLA
VLA
Myocardial Perfusion
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial Perfusion
82Rb PET: left normal; right abnormal perfusion study
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial Perfusion
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Cardiac CT
Clinical Scanners
• High temporal and spatial
resolution
• Gantry rotation times of 420
ms or shorter
• Spatial resolution of 0.4 by 0.4
by 0.4 mm
• “state-of-the-art” equipment for
CTA
• Breath hold is 6 to 12 s
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Cardiac CTCoronary Artery Calcium Scanning
• Non-contrast study
• Refine clinically predicted risk
of CHD beyond that predicted
by standard cardiac risk factors
• Used in asymptomatic patients
• Coronary calcium Present in
direct proportion to extent of
atherosclerosis
• Minority (20%) of plaque is
calcified
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Cardiac MRIQuantitative Data on ventricular chambers
(a) Coronal scout; (b) end-
diastolic image in axial
projection; (c) end-diastolic
image
on long vertical axis; (d)
end-diastolic image on
long horizontal axis; (e)
end-diastolic image on
long vertical axis that is
used in alternative for
obtaining images on the
short axis; (f) end-diastolic
image on short axis at
medium ventricular level
that is used in alternative
for obtaining images on
the long horizontal axis
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial MetabolismFatty Acid Metabolism
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial MetabolismFatty Acid Metabolism
Serial dynamic images (2 mm per frame) of myocardiumafter administra tion
of [‘1C]palmitatotehealthy volunteer. Note high myocardial uptake in early
stage, with rapidwashoutfrom myocardium.
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial MetabolismFatty Acid Metabolism
Series of short-axisslices of
(A) resting and
(B) delayed thallium (TL) scans and
(C) BMIPPscan of patient with
unstable angina. Although thallium
did not show definite perfusion
abnormalities,decreased BMIPP
uptake was notedin lateral region.
1st Faculty of Medicine, Charles University in Prague
Center for Advanced Preclinical Imaging (CAPI) s.eigner@seznam.cz
Myocardial Metabolism18F-FDG
[18F] FDG cardiac PET/CT in a normal mouse (top) and in a mouse with myocardial
infarction (lower). FDG cardiac uptake is uniform in the normal mouse, while there
is an area of absent uptake in the anteroapical region of the mouse with myocardial
infarction.
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