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Curriculum in Cardiology Images
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
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
Figure 1: (1) What scans she underwent? (2) What are the findings?.
for the patient. On presurgery, she was referred to nuclear cardiology laboratory for evaluation. 1. What scans she underwent? 2. What are the findings?
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.
Address for correspondence: Dr. Chetan D. Patel, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi ‑ 110 029, India. E‑mail:
[email protected]
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DOI: 10.4103/2395-5414.201379
192
How to cite this article: Roy SG, Parida GK, Patel CD. Nuclear cardiology quiz. J Pract Cardiovasc Sci 2016;2:192-3.
© 2017 Journal of the Practice of Cardiovascular Sciences | Published by Wolters Kluwer - Medknow
[Downloaded free from http://www.j-pcs.org on Thursday, March 02, 2017, IP: 82.208.133.229] Roy, et al.: Nuclear cardiology quiz
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.[1] 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.[2] Then, the patient underwent coronary artery bypass surgery as revascularization improves the function of hibernating myocardium.[1] 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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Answer
There are no conflicts of interest.
1. The patient underwent resting N‑13 NH3 perfusion and F‑18 fludeoxyglucose (FDG) metabolic study for myocardial viability assessment 2. The adjacent rows show N‑13 NH3 perfusion and F‑18 FDG metabolic study, respectively. The rows 1–4 are short
References
Nil.
Conflicts of interest
1. Camici PG, Prasad SK, Rimoldi OE. Stunning, hibernation, and assessment of myocardial viability. Circulation 2008;117:103‑14. 2. Partington SL, Kwong RY, Dorbala S. Multimodality imaging in the assessment of myocardial viability. Heart Fail Rev 2011;16:381‑95.
Journal of the Practice of Cardiovascular Sciences ¦ Volume 2 ¦ Issue 3 ¦ September-December 2016
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