LEARN NUCLEAR MEDICINE
Cardiology · Case 07
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 40 year old man presents to the ED with dyspnea, and fatigue. He experiences pain that radiates to the left shoulder
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Read the images before opening the teaching panel below.
Multivessel Disease
Imaging Findings
Moderate size severe intensity perfusion defect involving the mid to distal anterior wall with extension into the apex. The stress EF drops from 54% at rest to 39% at stress which is concerning for multivessel disease.
Interpretation Schema
Same as SPECT except because patient is actively under stress while being imaged the failure of the EF to increase is indicative of multivessel disease even in the absence of a perfusion defect
Reversible Perfusion defect – perfusion defect (PD) on stress images, and normal perfusion on rest images – indicates ischemia.
Fixed PD – perfusion defect in both rest and stress images. Indicative of scar, hibernating myocardium, or artifact.
Gated Images – Provide ejection fraction (EF) and evaluation of wall motion – scar does not thicken, while attenuated, normal muscle does.
Tracers
PET – 87Rb
13N-Ammonia,,
Essential Facts
Lower radiation exposure compared to SPECT
Fewer artifacts
Better spatial resolution
Best for multivessel CAD
Risk Stratification
Coronary artery calcium
Quantification of absolute myocardial perfusion
References
https://docs.google.com/presentation/d/128G0nh6E1nXcgS6ZpqsS6iyZfdLZxgFv/edit#slide=id.p127 (no reference)
Di Carli, Marcelo F, and Venkatesh L Murthy. “Cardiac PET/CT for the Evaluation of Known or Suspected Coronary Artery Disease.” Radiographics : a Review Publication of the Radiological Society of North America, Inc, Radiological Society of North America, 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3173713/.