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TUTORIAL: Clinical PET Case 6 - Cardiology
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66 year-old male with occasional chest pain, J point depression (no ST depression at .80 after J point) on exercise ECGs since age 56; much concerned about CAD possibility.
Chart in the graphic below shows results of exercise ECGs:
Ultra-fast CT for detection of coronary calcium on 9/4/91:
- Dense calcific plaque in the proximal 2-3cm of LAD extending into the proximal diagonal branch suggestive of significant stenosis.
- Scattered calcific plaques throughout the LCx, not significant.
- Moderate calcific plaques on RCA ostium.
Rest T1-201/stress sestamibi SPECT on 9/30/91:
- Exercised for 11 minutes to HR-145 (81% max) 3 mm J point depression, 1mm ST depression at .08 after the J point.
- Normal rest and excercise myocardial perfusion SPECT images.
Because of the SPECT findings shown above, the physician did not proceed with coronary angiography for diagnosis of CAD, but suggested a repeat non-invasive evaluation in approximately one year.
Rest-exercise echocardiogram on 12/4/92:
- Exercised for 13 minutes to HR-156 (90% max) 4 mm J point depression, 3 mm ST depression at .08 after the J point in the inferior and lateral precordial leads, became 4 mm downsloping during the recovery and persisted for several minutes.
- Normal rest and exercise regional and global function, LV wall thickness of 1.2 cm.
Despite worsening of exercise ST segment depression, there was not echocardiograhic evidence for ischemia. The patient and physician remained concerned about coronary artery disease because chest pain episodes continued. The patient has been referred to you for evaluation of the presence, severity and extent of myocardial ischemia/CAD.
Imaging
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