Multiple-Gated Acquisition (MUGA) Scan

The multiple-gated acquisition (MUGA) scan is a non-invasive nuclear test that uses a radioactive isotope called technetium to evaluate the functioning of the heart's ventricles.

Purpose

The MUGA scan is performed to determine if the heart's left and right ventricles are functioning properly and to diagnose abnormalities in the heart wall. It can be ordered in the following patients:

• with known or suspected coronary artery disease,to diagnose the disease and predict outcomes
• with lesions in their heart valves
• who have recently had a heart attack, to assess damage to heart tissue and predict the likelihood of future cardiac events
• with congestive heart failure
• who have undergone percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, or medical therapy, to assess the efficacy of the treatment
• with low cardiac output after open-heart surgery
• who are undergoing chemotherapy

Precautions

Pregnant women and those who are breastfeeding should not be exposed to technetium.

Description

The MUGA scan measures the heart's function and the flow of blood through it. The strongest chamber in the heart is the left ventricle, which serves as the main pump of blood through the body. The left ventricular is assessed by measuring the amount of blood pumped with each heartbeat (the ejection fraction), ventricle filling, and the blood flow into the pumping chamber. A normal ejection fraction is 50% or more. The heart's ejection fraction is one of the most important measures of its performance. The right ventricle's ability to pump blood to the lungs is also assessed, and any abnormalities in the heart wall are identified. The MUGA scan is the most accurate, non-invasive test available to assess the heart's ventricles.

MUGA is a nuclear heart scan, which means that it involves the use of a radioactive isotope that targets the heart and a radionuclide detector that traces the absorption of the radioactive isotope. The isotope is injected into a vein and absorbed by healthy tissue at a known rate during a certain time period. The radionuclide detector, in this case a gamma scintillation camera, picks up the gamma rays emitted by the isotope.

During the MUGA scan, electrodes are placed on the patient's body so that an electrocardiogram (ECG) can be conducted. The imaging equipment and computer are synchronized with the ECG so that images of the heart can be recorded without motion or blur. Then a small amount of a mildly radioactive isotope called technetium Tc99m stannous pyrophosphate, usually called technetium, is injected, usually into an arm vein. While the patient lies motionless on the test table, a gamma scintillation camera follows the movement of the technetium through the blood circulating in the heart. The camera, which looks like an x-ray machine and is suspended above the table, moves back and forth over the patient. It displays multiple images of the heart in motion and records them on a computer for later analysis.

The MUGA scan is usually performed in a hospital's nuclear medicine department, but it can also be performed in an outpatient facility or at the patient's bedside if equipment is available. The scan is done immediately after injection of the technetium and usually takes about 30 minutes to one hour. It is also called multigated graft acquisition, multigated acquisition scan, cardiac blood-pool imaging, and equilibrium radionuclide angiography. Test results can be affected by patient movement during the test, electrocardiogram abnormalities, an irregular heartbeat, or long-acting nitrates.

The MUGA scan can be done with the patient at rest or exercising (called a stress MUGA). The stress MUGA is often performed in patients who have or are suspected of having coronary artery disease. The resting MUGA is compared to the stress MUGA and changes in the heart's pumping performance are analyzed. In some cases, the rest MUGA is compared to a nitroglycerin MUGA, in which a strong heart drug called nitroglycerin is administered to the patient before the scan. For the nitroglycerin MUGA, a cardiologist should be present.

The MUGA scan is not dangerous. The technetium is completely gone from the body within a few days of the test. The scan itself exposes the patient to about the same amount of radiation as a chest x ray. The patient can resume normal activities immediately after the test.

Normal results

If the patient's heart is normal, the technetium will appear to be evenly distributed in the scans. In a stress MUGA, patients with normal hearts will exhibit an increase in ejection fraction or no change.

Abnormal results

An uneven distribution of technetium in the heart indicates that the patient has coronary artery disease, a cardiomyopathy, or blood shunting within the heart. Abnormalities in a resting MUGA usually indicate a heart attack, while those that occur during exercise usually indicate ischemia. In a stress MUGA, patients with coronary artery disease may exhibit a decrease in ejection fraction.