Case Study #3

Reversible Inferior Wall Defect




Patient History

Patient is a 56 year old male who was referred because of increased dyspnea with minimal exertion, diabetes, high cholesterol, peripheral neuropathy and obesity.




Imaging Procedure

The Two Day Cardiolite Protocol was followed, and rest imaging was performed first. Imaging was done on a GE Millennium MG Dual Head Camera with 36 stops/ detector, 180 degrees. Images were acquired with ACuscan™ attenuation correction methodology using two movable gadolinium-153 transmission line sources.

Acquisition Parameters:

 Type of AcquisitionTime per stopAgentDoseInjection-Image Interval
RestUngated SPECT22 seconds99mTc Sestamibi45 mCi45 minutes post-injection
StressGated SPECT20 seconds99mTc Sestamibi45 mCi30 minutes post-injection


Patient exercised 9 minutes on the modified Bruce protocol to a heart rate of 142 (86% of maximum heart rate) and 6.0 METS. EKG results showed some ST depression in leads II and V6.

Reversible Inferior Wall Defect




Clinical Findings:

Both non-attenuation corrected and attenuation corrected images reveal reversible basal inferior wall changes with persistent thinning of the apex. The attenuation corrected images actually show the percent of reversibility in the infero-lateral wall better than the non-attenuated images. Patient was subsequently sent to the cath lab and the RCA was stented, showing a tight 70% stenosis. The circumflex also had diffuse disease throughout.


Images Courtesy of:
Lakeside Cardiology,
Milwaukee, Wisconsin