PET REST AND STRESS MYOCARDIAL PERFUSION AND GLUCOSE METABOLISM STUDY

DATE: 8/24/2006

PROCEDURE:  After IV injection of N-13 ammonia, images of resting myocardial perfusion were acquired on a Siemens/CTI PET Scanner.  Under physician supervision with cardiac monitoring, a pharmacological stress test was performed, and the patient was reinjected with N-13 ammonia for stress imaging.  The patient was then loaded with glucose to promote myocardial uptake of 18-fluoro-2-deoxygluose (FDG) which was injected IV. After a standard uptake period, myocardial metabolism images were acquired.  All three image sets were reconstructed into transaxial images with attenuation correction based on a pre-tracer injection transmission scan and were resliced into short-axis, vertical long-axis, and horizontal long-axis images.  

SESSION NUMBER: P00000

STRESS AGENT AND DOSE:  Dobutamine: [...] mg        Adenosine: [...] mg

REST	N-13 Ammonia DOSE: [30] mCi

STRESS	N-13 Ammonia DOSE: [30] mCi

18-Fluoro-2-Deoxglucose DOSE: [10] mCi

Aminophyilline dose: None

COMPARISON: None

CLINICAL HISTORY: The patient is a [...]-year-old [fe]male with a history of [...] who is being evaluated for stress induced ischemia and myocardial viability.  The patient is referred for assessment of stress induced ischemia and myocardial viability.

EKG Rest: Normal sinus rhythm. No Q waves, T wave inversions, or ST segment changes. 
 
EKG Stress: No ischemic ST segment changes.

Symptoms: Mild shortness of breath, flushing that resolved 1-2 minutes post adenosine infusion.

STRESS RESPONSE:  

Heart Rate at Rest: [...] bpm

Heart Rate at Peak Stress: [...] bpm  

Blood Pressure at Rest: [...] mmHg

Blood Pressure at Peak Stress: [...] mmHg

MYOCARDIAL PERFUSION STUDY:

Perfusion Stress: 

Normal perfusion to all walls of the left ventricular myocardium. Mild decrease in tracer activity in the proximal to mid inferior wall. Moderate to severely decreased tracer activity in the proximal to distal inferior wall extending into the inferoapical region. Homogeneous normal activity in the remainder of the left ventricular myocardium.

Severely decreased tracer activity in the proximal to distal inferorlateral wall. Homogeneous normal activity in the remainder of the left ventricular myocardium.

Perfusion Rest: 

Unchanged from perfusion with stress.

Glucose Metabolic Study: 

Normal metabolic activity in all walls of the left ventricular myocardium. Mild decrease metabolic activity in the proximal to mid inferior wall. Moderate to severely decreased metabolic activity in the proximal to distal inferior wall extending into the inferoapical region. Homogeneous normal activity in the remainder of the left ventricular myocardium.

Moderately large hypometabolism in the mid to distal inferior wall.

Left Ventricular Chamber Size: Normal

CONCLUSIONS:

1. Normal myocardial perfusion with no evidence for stress-induced ischemia or myocardial infarction.

2. Normal left ventricular chamber size.

3. The likelihood for hemodynamically significant coronary artery disease is very low.

1. Fixed severe perfusion defect in the mid to distal inferior wall.

1. Perfusion-metabolism mismatch pattern in the proximal to distal inferolateral wall, suggesting hibernating/viable myocardium in this region.

Please note that the FDG images are of poor quality due to type II diabetes and insulin resistance (despite many hours of attempts to get better images).

Thank you for referring this patient to the UCLA Nuclear Medicine Clinic.

I, [...], M.D., Ph.D., have reviewed this Nuclear Medicine study personally, and am in full agreement with the findings of the report presented here.