GATED MIBI MYOCARDIAL SPECT SHOWING BALANCED ISCHEMIA AND GLOBAL HYPOKINESIA IN PATIENT HAVING THROMBUS IN BASAL SEGMENT OF DOMINANT CIRCUMFLEX SYSTEM BLOCKING BOTH LEFT ANTERIOR DESCENDING AND CIRCUMFLEX ARTERY
AbstractMyocardial perfusion imaging (MPI) is a powerful diagnostic and prognostic tool for evaluatingcoronary artery disease (CAD). Gating myocardial perfusion gives important diagnostic and prognosticinformation. This 43 years old patient was referred for cardiac scan. Exercise stress test showed > 2mmhorizontal ST segment depression. Cardiac scan was normal except for left ventricular cavity dilatationon stress images. Gated images showed global hypokinesia and increased end-diastolic volume. Patientwas suspected to have balanced ischemia and was referred for Angiography. Angiography showed totalocclusion with no flow in proximal Left Anterior Descending Artery and distal circumflex artery. It isvery important to evaluate symptomatic patients and patients with risk factors carefully with normalmyocardial perfusion scan.
Kapetanopoulos A, Ahlberg AW, Taub CC, Katten DM, Heller
GV. Regional wall-motion abnormalities on post-stress
electrocardiographic-gated technetium-99m sestamibi singlephoton emission computed tomography imaging predict cardiac
events. J Nucl Cardiol 2007;14(6):810–7.
DePuey EG, Rozanski A. Using gated technetium-99m-sestamibi
SPECT to characterize fixed myocardial defects as infarct or
artifact. J Nucl Med 1995;36:952–5.
Smanio PE, Watson DD, Segalla DL, Vinson EL, Smith WH,
Beller GA. Value of gating of technetium-99m sestamibi singlephoton emission computed tomographic imaging. J Am Coll
Rehn T, Griffith LS, Achuff SC, Bailey IK, Bulkley BH, Burow
R, et al. Exercise thallium-201 myocardial imaging in left
main coronary artery disease: sensitive but not pecific. Am J
Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV,
Berman DS, et al. American College of Cardiology; American
Heart Association Task Force on Practice Guidelines; American
Society for Nuclear Cardiology. ACC/AHA/ASNC guidelines
for the clinical use of cardiac radionuclide imaging--executive
summary: a report of the American College of Cardiology/
American Heart Association Task Force on Practice Guidelines
(ACC/AHA/ASNC Committee to Revise the 1995 Guidelines
for the Clinical Use of Cardiac Radionuclide Imaging).
DePuey EG, Rozanski A. Using Gated Technetium-99msestamibi SPECT to characterize fixed myocardial defects as
infarct or artifact. J Nucl Med 1995;36: 952–5.
Smanio PE, Watson DD, Segalla DL, Vinson EL, Smith Wh,
Beller GA. Value og Gating og Technetium-99m sestamibi
single photon emission computed tomographic imaging. J Am
Coll Cardiol 1997;30:1687–92.
Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF,
Froelicher VF, et al. ACC/AHA 2002 guideline update for
exercise testing: summary article. A report of the American
College of Cardiology/American Heart Association Task Force
on Practice Guidelines (Committee to Update the 1997 Exercise
Testing Guidelines). J Am Coll Cardiol 2002;40:1531–40.
Kumar SP, Brewington SD, O'Brien KF, Movahed A. Clinical
correlation between increased lung to heart ratio of technetium-
m sestamibi and multivessel coronary artery disease. Int J
Abidov A, Bax JJ, Hayes SW, Hachamovitch R, Cohen I,
Gerlach J et al. Transient ischemic dilation ratio of the left
ventricle is a significant predictor of future cardiac events in
patients with otherwise normal myocardial perfusion SPECT. J
Am Coll Cardiol 2003;42:1818–25.
Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson
E, Friedman JD, et al. Identification of severe and extensive
coronary artery disease by automatic measurement of transient
ischemic dilation of the left ventricle in dual-isotope myocardial
perfusion SPECT. J Am Coll Cardiol 1996;27:1612–20.
Sharir T, Germano G, Kavanagh PB, Lai S, Cohen I, Lewin HC,
et al. Incremental prognostic value of post-stress left ventricular
ejection fraction and volume by gated myocardial perfusion
single photon emission computed tomography. Circulation
Schuijf JD, Poldermans D, Shaw LJ, Jukema JW, Lamb HJ, de
Roos A, et al. Diagnostic and prognostic value of non-invasive
imaging in known or suspected coronary artery disease. Eur J
Nucl Med Mol Imaging 2006;33:93–104.