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Patient
History
Patient is a 45 year old male who
presented with mild chest pain following low level
exertion. The patient had no risk factors for cardiac
disease (normal cholesterol, exercises, non-smoker, no
family history of cardiac events). Height: 69 inches;
weight: 175 lbs.
Imaging
Procedure
The Two Day Cardiolite Protocol was
used, and rest imaging was performed first. Imaging was
done on a GE
Millennium MG Dual Head Camera with 36
stops/detector, 180 degrees.
Acquisition
Parameters:
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Type of Acquisition |
Time per stop |
Agent |
Dose |
Injection-Image
Interval |
| Rest |
Ungated SPECT |
25 seconds |
99m Tc Sestamibi |
25.8 mCi |
45 minutes after injection |
| Stress |
Gated SPECT |
25 seconds |
99m Tc Sestamibi |
26.9 mCi |
40 minutes after
injection |
Target heart
rate (85% of maximum heartrate): 149 bpm. Maximal heart
rate achieved on treadmill: 121
bpm.
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Imaging Analysis
This data was reconstructed and reformatted using the ECToolbox.
Slices were reviewed in the Planar/ Slice review. Slices were automatically aligned
(since the data had already been processed with CEqual) and normalized to the
maximum in the myocardium. There is a handy button on this review ???change map???
which makes it easy to switch maps from color to black and white as needed to
review the slices.
 If
the color map of the projection images is changed to inverse, the rest projection
images clearly show the hotter counts on the lower border of the heart to come
from a loop of bowel behind the heart (views 15 and 39).
Note:
Reconstruction and reformatting could have been done by QGS/QPS,
Cardiac SPECT, or the ECToolbox
(they all use the same format) or by the MyoSPECT
protocol.
This data was processed with
the CEqual option of the ECToolbox.
The reversible nature of the defect is clearly seen in the
CEqual plots and SSS scores, and is affirmed in the Perfex
results available on the Plot review. .
 The
deep teal color in the standard deviation polar plots emphasizes the severity
of this defect (7-8 SD below normal); the extent scores show the size of the defect
as well as the total per cent of the myocardium affected. The blackout 3D with
superimposed arteries visually reaffirms the location and extent of the defect.
 This
data was further processed with QGS
to give additional gated and 3D information. QGS will use as input the slices
created in the ECToolbox. There is no need to reconstruct the data in QGS. The
totally automatic wire mesh surfaces give a good global impression of the heart's
motion. The reference static and beating 3D surfaces in Views are also helpful.
The QGS beating slices and wire mesh surfaces show moderate wall motion.
 The
reversible nature of the defect can be seen on the 2D and 3D perfusion surfaces.
 MyoSPECT
was then used to show all three sets of slices at one time ??? rest, stress, and
stress gated. Since the slices were already created, there was no need to reconstruct
them in MyoSPECT. The slices can easily be aligned in MyoSPECT by dragging the
appropriate dataset. The number of slices to be viewed can be selected right in
the work area. Contours and beating slices can be shown on this review. 3D surfaces
and plots can be added, and they visually reinforce the reversible nature of the
defect.
EKG Results
The EKG
showed 2.2 mm of ST depression in AVF, and 1.8 mm of ST
elevation in V2. Findings were consistent with inferior wall
ischemia.
Findings
There was a large
zone of stress-induced ischemia in the anterior wall and
septum. Left ventricular function was normal. Cardiac
catheterization revealed 95% stenosis of LAD (mid segment). A
stent was placed at the site of narrowing, and the patient now
has a 0% stenosis.
Images courtesy
of:
Oconomowoc Memorial Hospital, Oconomowoc,
WI
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