Case Studies in Nuclear Cardiology
Case 1(fig 2,3): Mr. R, 40 yr male, a typical chest pain; Normotensive,non-diabetic, strong family history of CAD - Thallium 201 SPECT - Anterior wall and Septum- reversible perfusion defect- Angio- 80% stenosis LAD(single vessel disease) -Normal
post angioplasty.
Case 2(fig 4,5): Mr. K, 60 yr male - history of infarction 3 months before imaging- Angio showed 100% block in LAD and 60% stenosis in RCA. 99mTc MIBI SPECT shows large fixed perfusion defect in Anterior wall and Apex(irreversible infarction). Since patient was not having
anginal symptoms and no other areas of inducible ischemia a decision to continue medical therapy was taken instead of CABG/Angioplasty. Revascularisation in LAD in this case would not help because of irreversibility of Anterior wall.
Case 3(fig 6): Mr. H, 55 yr male - history of anginal symptoms; Single acute episode of infarction; hypertensive- borderline positive stress test- Angio showed 90% lesion of LAD-Echo
showed dyskinesia of Anterior wall, apex, septum- 99mTc Tetrafosmin SPECT shows large reversible
perfusion defect in Anterior wall and Septum. Small infarct seen in Inferior wall. CABG performed with good results. These are a few examples of how Myocardial Perfusion Scanning helps in decision making in Coronary artery disease - the field in growing fast and awareness of noninvasive cardiac imaging is progressing.
