MYOCARDIAL SPECT PERFUSION STUDY

CLINICAL HISTORY: The patient is a [...]-year-old [fe]male with [...]. The patient is referred to Nuclear Medicine for evaluation of possible stress induced ischemia.

COMPARISON: None.

Mode of Stress: Treadmill.

TECHNIQUE:  After injection of technetium 99m Cardiolite, resting SPECT images of the heart were acquired.  Subsequently, 99mTc Cardiolite was injected at peak stress and gated SPECT images of the heart were obtained.

RADIOPHARMACEUTICAL DOSE:
99m Tc Sestamibi Rest: [8] mCi
99m Tc Sestamibi Stress: [25] mCi

FINDINGS:

Treadmill performance:

The patient exercised according to the BRUCE protocol for [...] minutes, achieving a work level of maximum METS [...]. The resting heart rate of [...] bpm rose to a maximal heart rate of [...] bpm. This value represents [...]% of the maximal, age-predicted heart rate. The resting blood pressure of [...] mmHg, rose to a maximum blood pressure of [...] mmHg. The exercise test was stopped due to target heart rate achieved.

ECG Summary: Resting ECG: normal sinus rhythm. Function capacity: normal. HR response to exercise: appropriate. BP response to exercise: normal resting BP-appropriate response. Chest pain: none. Arrhythmias: none. ST changes: none. Overall impression: Normal stress test.

MYOCARDIAL PERFUSION STUDY:

Left ventricular chamber size:  Normal.

PERFUSION WITH STRESS: Normal perfusion to all walls of the left ventricular myocardium. Mild decrease in tracer activity in the proximal to mid inferior wall. Mild decrease in tracer activity in the distal anteroseptal wall. Normal perfusion to the rest of the left ventricular myocardium. Normal perfusion to all walls of the left ventricular myocardium.  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.

PERFUSION AT REST: Normal. Unchanged from perfusion with stress. The fixed defect of the inferior wall is most likely due to diaphragmatic attenuation. The fixed defect of the distal anteroseptal wall is most likely due to breast attenuation. 
 
Gated study 15-20 minutes post stress: Normal motion and wall thickening. Mild septal hypokinesis consistent with the patient's history of CABG.

Estimated left ventricular ejection fraction: [...]%.

Comparison with the previous myocardial perfusion scan of […] indicates that there has been no significant interval change.

IMPRESSION: 

1. Normal study with no scintigraphic evidence for stress induced ischemia or prior myocardial infarction.

2. The left ventricle is of normal size and demonstrates normal wall motion with an estimated ejection fraction of [...]%.

1. Fixed perfusion defect in the inferior wall extending into the apex which is consistent with prior infarction in the RCA territory. There is no evidence for stress induced ischemia.

2. Wall motion abnormalities as noted above. Estimated left ventricular ejection fraction is […]%.

3. No significant interval change compared to the previous myocardial perfusion scan of […].