|CURRICULUM IN CARDIOLOGY - IMAGES
|Year : 2016 | Volume
| Issue : 3 | Page : 192-193
Nuclear cardiology quiz
Shambo Guha Roy, Girish Kumar Parida, Chetan D Patel
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||2-Mar-2017|
Chetan D Patel
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy SG, Parida GK, Patel CD. Nuclear cardiology quiz. J Pract Cardiovasc Sci 2016;2:192-3
| Question|| |
A 66-year-old diabetic, hyperlipidemic female presented with heart failure. Her coronary angiography revealed triple vessel disease. Coronary artery bypass grafting was planned for the patient. On presurgery, she was referred to nuclear cardiology laboratory for evaluation.
- What scans she underwent?
- What are the findings?
| Answer|| |
- The patient underwent resting N-13 NH3 perfusion and F-18 fludeoxyglucose (FDG) metabolic study for myocardial viability assessment
- The adjacent rows show N-13 NH3 perfusion and F-18 FDG metabolic study, respectively. The rows 1–4 are short axis images; 5 and 6 are vertical long axis; and 7 and 8 are horizontal long axis images [Figure 1].
Perfusion images show large, hypoperfused area in the anteroseptal wall and apex [white arrows in [Figure 2]
. Metabolic images show preserved FDG uptake in the corresponding areas [Figure 2]
. This “perfusion and metabolic mismatch” defect in the anteroseptal wall and apex is consistent with hibernating myocardium.
|Figure 2: Perfusion images show large, hypoperfused area in the anteroseptal wall and apex (white arrows). Fludeoxyglucose images show preserved uptake in the corresponding areas.|
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The polar map shows perfusion defect (blacked out area in the N-13 NH3 study) involving the anteroseptal wall and apex, which shows mismatch with FDG images [white area, [Figure 3]
]. Software quantification shows 26% left ventricular myocardium is hibernating.
Then, the patient underwent coronary artery bypass surgery as revascularization improves the function of hibernating myocardium.
Financial support and sponsorship
|Figure 3: The polar map showing perfusion defect (blacked out area in the N-13 NH3 study) involving the anteroseptal wall and apex, which shows mismatch with fludeoxyglucose images (white area).|
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Nil.Conflicts of interest
There are no conflicts of interest.
| References|| |
Camici PG, Prasad SK, Rimoldi OE. Stunning, hibernation, and assessment of myocardial viability. Circulation 2008;117:103-14.
Partington SL, Kwong RY, Dorbala S. Multimodality imaging in the assessment of myocardial viability. Heart Fail Rev 2011;16:381-95.
[Figure 1], [Figure 2], [Figure 3]