A multi-gated (MUGA) cardiac blood pool scan (sometimes just called a MUGA scan) is a common study performed in patients who are receiving potentially cardiotoxic chemotherapy.
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Indications
- acute myocardial infarction (AMI)
- coronary artery disease (CAD)
- evaluation after coronary artery bypass graft surgery
- cardiomyopathy/myocarditis
- assessment of drug therapy
- pulmonary disease
- right ventricular (RV) enlargement
- cor pulmonale
- normal left ventricular (LV) ejection fraction, wall motion and chamber size strongly suggests a pulmonary etiology
Tracer dose and route of administration
Technique
- patient in normal sinus rhythm
- IV administration of Tc-99m-labeled RBCs
- ECG gated – with R wave gating
- minimum of 16 frames/cardiac cycle
- at rest and exercise
First pass study
This is obtained by injecting a compact bolus of suitable radiopharmaceutical intravenously. This stage is favorable for intracardiac shunts and ejection fraction calculation 2.
- major advantage: data collected rapidly over very few cardiac cycles allows measurement of ventricular function at peak stress during exercise ventriculography
- major disadvantage: counting statistics are low and only a limited number of views are possible
Analysis
- qualitative analysis
- quantitative analysis
- functional parameters
- wall motion assessment (regional and global)
- end-diastolic (ED) and end-systolic (ES) ventricular volumes
- stroke volume
- cardiac output
- ejection fraction (LV and RV)
- regurgitant fraction (stroke index ratio)
- ventricular filling and emptying rates
- cardiac shunt quantitation
- left to right shunts: evaluated using the first transit technique (not equilibrium)
- right to left shunts: evaluated using Tc-99m labeled macro aggregated albumin and comparing the ratio of tracer in the lung to tracer gaining access to the systemic circulation
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