LEARN NUCLEAR MEDICINE
Cardiology · Case 05
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 60 year old female presents with atypical chest pain and is referred to your clinic for preoperative evaluation. Her risk factors include smoking, diabetes, hyperlipidemia and sedentary life
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Read the images before opening the teaching panel below.
Mildly decreased perfusion in the inferior and lateral wall.
Imaging Findings
Decreased perfusion within the inferior and lateral walls with an associated dilatation of the LV cavity (TID ratio is 1.23). EF is decreased at stress compared to rest with associated increased EDV.
Essential Facts
Transient ischemic dilatation is believed to be secondary to diffuse sub-endocardial ischemia
Normal TID ratio varies, in general look visually for dilatation of the LV cavity at stress
Balanced ischemia secondary to multi-vessel coronary artery disease leading to sub-endocardial ischemia
One may not see reduced EF with SPECT secondary to time that has lapsed between stressing patient and acquiring images (30-45 min)
On PET one will see a failure of the EF to increase with stress or drop in EF, this is concerning for multi-vessel disease even in the absence of a perfusion abnormality.
References
Dvorak, Ryan A., et al. “Interpretation of SPECT/CT Myocardial Perfusion Images: Common Artifacts and Quality Control Techniques.” RadioGraphics, 8 Nov. 2011, pubs.rsna.org/doi/full/10.1148/rg.317115090.
https://docs.google.com/presentation/d/11xb66_k3nFeiInwWarKhSWpL_G9FJzJ4/edit#slide=id.p11 (No References Found on slides)