Published on 02/03/2015 by admin
Filed under Internal Medicine
Last modified 03/03/2015
This article have been viewed 937 times
Case 8
A 51-year-old man with hyperlipidemia was referred for exercise SPECT MPI for evaluation of nonexertional localized chest pain.
He exercised for 8:54 minutes on a Bruce protocol, achieving an estimated workload of 10 METs. No exercise-induced symptoms were reported, and the blood pressure and ECG responses were normal.
The SPECT images demonstrate a mild, nonreversible reduction in tracer activity in the lateral, anterior, inferior, and apical regions (relative to the septum). This perfusion pattern (highest myocardial tracer activity in the septum) is abnormal. In men, the highest myocardial tracer activity is typically found in the anterolateral region, since this region is least susceptible to photon attenuation. The observed perfusion pattern in this patient could represent multivessel coronary artery disease (CAD) with extensive subendocardial infarction, severe soft-tissue attenuation artifact, or increased septal wall thickness. Because of the limited spatial resolution of the SPECT camera, the apparent tracer activity in a myocardial region is directly related to the thickness of the myocardial wall. This is referred to as the “partial volume effect.”
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