NC Today: Challenges and Controversies: Case-based Discussion
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PROGRAM OVERVIEW | VIEW AGENDA
View the Nuclear Cardiology Today controversial cases to be discussed and join us in Boston, MA, April 28-29, 2023.
The program will include 4 intensive, interactive case-based learning modules. Each starts and ends with a case discussion and will feature 2-3 practical dilemmas to encourage peer-to-peer discussion of best approaches to solve everyday clinical issues.
The sessions will include Cardiac Amyloidosis, SPECT, PET, and PatientFirst Imaging with a focus on the controversies and decision points that experts will debate live at NC Today. Register now to reserve your front-row seat and join in the discussion!
Challenges and Controversies: Case-based Discussion
- How do you report a study if the perfusion images are normal but global myocardial blood flow reserve is severely abnormal? What do you do next?
- The MBFR is reduced because resting MBF is high. Should resting MBF be corrected for RPP, and if so should the “real” MBFR or the corrected MBFR be reported?
- Can a diagnosis of coronary microvascular disease be made on the basis of MBFR alone, or is anatomic assessment required?
- If you suspect inadequate suppression of physiologic myocardial FDG uptake, do you repeat the test with extended patient prep?
- How to interpret a PET perfusion defect if regional flow in that territory is convincingly normal?
- Do you ever repeat a PET scan because the MBF data is technically unusable?
- When do we use FDG PET or WBC scan in endocarditis?
- Should we use heparin as part of the sarcoid prep?
Challenges and Controversies in Cardiac Amyloidosis: Cases with ACEs
- I am gene positive for TTR, my Tc-99m PYP and Echos are normal. When, if at all, should the Tc-99m PYP study be done?
- 70-yr-old male presents with signs and symptoms of ATTR amyloid. Tc-99m PYP scan is grade 1. Do you proceed to CMR or end-myocardial biopsy or initiate treatment for TTR amyloidosis?
- Is there any reason to report H/CL ratio if SPECT is done?
- Should we get a gene test in everyone with suspected ATTR amyloid? (Can we say that a pt does not have cardiac amyloidosis based just on normal PYP and serum/urine studies if the echo is suspicious?)
- Revisiting 1 hr vs 3 hr PYP in the current era of mandatory SPECT. Do we lose sensitivity with delayed imaging? Especially with HMDP?
- Are there other findings on SPECT- CT beyond LV uptake that are helpful in diagnosis amyloid (atrial uptake, RV uptake)?
- Can I do serial PYP scans to determine if tafamidis therapy for ATTR-CM is effective? Most patients who undergo Tc-99m PYP scans have many incidental findings (especially of using SPECT/CT), how much to report? What is the best wording? When readers say “recommend formal diagnostic CT,” provider is obligated to follow up. Implications?