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Radionuclide angiography has been applied extensively in all areas of cardiac disease, including diagnosis of coronary artery disease and cardiomyopathy, and for prognosticating, making management decisions, and evaluating therapy in patients with coronary artery disease, valvular heart disease, and heart failure of diverse etiologies.

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We obtain a series of images over several hundred beats displayed as a continuous cine loop.Using a standard Anger scintillation camera and a gating mechanism interfaced to its computer, we can examine the phases of diastole in addition to calculating the global ejection fraction from changes in counts from ED to ES.Images acquired after the radionuclide reaches equilibrium within the intravascular compartment enables creation of composite images in multiple views.High resolution collimation used with the multigated technique provides enhanced temporal resolution and quantitative precision.Important technical limitations remain, including the relatively restricted spatial resolution of standard Anger cameras, precluding precise evaluation of regional LV abnormalities, and overlap of atria and ventricles during equilibrium studies, even in the standard left anterior oblique view, limiting precision in measuring LV and RV volumes.

SPECT technology has been applied to blood pool imaging to overcome these problems, providing some obvious advantages over planar imaging.Gated equilibrium studies require a radiopharmaceutical that remains within the vascular space for the duration of the study.The first agent used as a blood pool tracer was 99m Tc human serum albumin (1964), but was found to be less than ideal.The radiotracer of choice is Technetium 99m- autologous red blood cells, labeled in-vivo, in-vitro, or a combination of the two.Statistically, counting data over hundreds of cardiac cycles in multiple views usually affords us a more accurate assessment of cardiac function than a single-pass of a radioactive bolus.One major advantage to performing a SPECT MUGA is to assess right ventricular function in patients with congenital abnormalities, patients with heart failure, or patients for whom anesthesia might pose a risk.