LEARN NUCLEAR MEDICINE
Cardiology · Case 06
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
73 year old male with suspected septal wall infarct and known reduced ejection fraction presents for PET viability study to determine if the patient is a surgical candidate.
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Read the images before opening the teaching panel below.
Viable myocardium within the septal wall
Imaging Findings
Resting perfusion images demonstrate a moderate size area of moderately decreased perfusion within the septum. FDG images demonstrate intense FDG metabolism within the septum, specifically within the area of perfusion abnormality.
Essential Facts
Hibernating myocardium: Viable but chronically ischemic myocardium demonstrates decreased perfusion with associated hypokinesis and has a similar appearance to an infarct on SPECT and
The decreased perfusion and associated reduced wall motion is reversible with restoration of flow. On PET viability imaging the presence of FDG metabolism within the same region of perfusion abnormality is consistent with viable myocardium. An infarct will show matched decreased perfusion and decreased metabolism.
It is important to note that FDG myocardial viability images should not be interpreted without concomitant perfusion images.
References
Partington, Sara L, et al. “Multimodality Imaging in the Assessment of Myocardial Viability.” Heart Failure Reviews, U.S. National Library of Medicine, July 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3954520/
Guibinni, Raffaele. Myocardial Viability Detected with SPECT Perfusion Image. humanhealth.iaea.org/HHW/NuclearMedicine/CardiovascularandPulmonary/IAEATrainingCoursesandMeetings/RegionalTrainingCourseNuclearCardiology/Viability.pdf.
Peuy, E Gordon, and Munir Ghesani. “Myocardial Viability.” Article – Myocardial Viability, appliedradiology.com/articles/myocardial-viability.