Radionuclide ventriculography

(RVG)

Yang Ji Qin
Department of Nuclear Medicine
AFF. Hospital of NXMC
Qin-yj06@163.com
 The goal of radionuclide ventriculography
is to evaluate global and regional ventricular function.
 RVG
2 method The gated equilibrium
Study has become the
standard method
at most centers .

The first-pass The equilibrium

method method

in which all data collection in which data are

occurs during the initial
transit of a tracer bolus
through the central
circulation
collected over many
cardiac cycles using ECG
gating and a tracer that
remains in the blood pool.
 A major advantage of the radionuclide
method is that calculation of LVEF is not
dependent on mathematical assumptions of
ventricular shape. Emitted counts in the
ventricle are proportional to its volume.
 Equilibrium Blood Pool
Radiopharmaceutical

Radiolabeled human serum albumin was

originally used; however, radiolabeled RBCs
have been the standard technique for
decades.
 Equilibrium Blood Pool
Radiopharmaceutical
Labeling of RBCs can be performed by
any of three approaches: in vivo, modified
in vivo, or in vitro.
The modified in vivo or the in
vitro method repreferred
Vivo
because of their higher binding
99mTC
efficiency, 85% to 90% and RBC
greater than 97%, respectively.
vitro
Modified vivo
 Equilibrium Gated Blood Pool
Studies

The limited counting statistics available

during a cardiac cycle and the desirability
of linking phase of the cardiac cycle to
image data underlie the equilibrium gated
blood pool method.
Equilibrium Gated Blood Pool Studies

Gamma (x,y)
Camera NM
console Minicomputer

ECG R Wave
SYNCHRONIZER
Data
Timing acquisition
pulse storage
analysis
Nonfade display
oscilloscope
 The cardiac cycle is usually divided into
16 frames by computer processing software .
Sufficient frames are needed to catch the peaks
and valleys of the cardiac cycle.
 Data Analysis and Study
Interpretation
1. Qualitative Analysis
Data Analysis and Study Interpretation

1. Qualitative Analysis

normal hypokinetic akinesis dyskinetic

2. Quantitative Data Analysis
 Ejection Fraction(EF)
The most frequently calculated quantitative
parameter of ventricular function is the LVEF,
defined as the fraction of the left ventricular end-
diastolic volume expelled during contraction.
Ejection fraction =
End diastolic counts − End systolic counts
End diastolic counts
The LVEF in normal subjects ranges from
50% to 75%.
 Each pixel in the cardiac image has its own cycle,
having an amplitude and a characteristic temporal
relationship(phase) with respect to the R wave.
Images portray

contractility contraction sequence

(amplitude) (phase).

The amplitude image The phase image portrays

portrays the maximum net
Count variation for each pixel
during the cardiac cycle.
the relative time delay from
the R wave to the start of the
cardiac cycle for that pixel.
 Fourier Phase Analysis
Abnormalities

Abnormal conduction
Wall motion abnormalities
patterns (WPW or BBB).
are portrayed on phase
cause affected areas to be
images as low-amplitude
out of phase with adjacent
areas.
portions of the ventricle as
Regions of paradoxical
a result of premature or
motion resulting from
left ventricular aneurysms
are 180 degrees “out of phase” delayed contraction .
with the ventricle
 Amplitude and phase maps are often displayed in color
to highlight the temporal sequences of cardiac chamber
emptying. The studies require exceptionally well-
synchronized data to be most useful for localizing
abnormal conduction pathways.
 Clinical applications

The RVG study is most commonly used to

calculate a LVEF in patients .

Patients with significant ischemia may havea

normal rest LVEF but have a fall in the LVEF or
regional motion abnormalities with exercise.
 Quiz
1. What is the most frequently calculated
quantitative parameter of ventricular function ?
and write down its definition.

2. What is paradoxical wall motion ? Is it clinical

significance?