Case Study 2

Patient History

Patient is an 82-year-old male who presented for preoperative cardiac evaluation prior to hip replacement surgery. Past medical history includes hypertension. Patient’s medication chart included ASA and Bisoprolol Fulmate.

Body Habitus

Height: 5’10”
Weight: 210lbs
BMI: 30.1 Kg/m2

SPECT Images

PET Images

Protocol Characteristics
Protocol SPECT PET
Mode of Stress Dipyridamole Dipyridamole
Clinical Response Non-ischemic Non-ischemic
Blood Pressure Response Normal Normal
ECG Response Negative Negative
Radiopharmaceutical Tc-99m Sestamibi Rubidium-82
Rest/Stress Dose 10mCi/33mCi 47mCi/47mCi
Gated Yes Yes
Length of Exam Time 2.5 hours 40 minutes



Fixed defect is noted at the apex, which does not move or thicken appropriately and likely represents a scar. There is no SPECT evidence of ischemia. LV ejection fraction of 40 percent (normal above 45 percent).

Note: At a BMI of 30, this patient is just over the line for being considered obese and turns out to present a challenge for SPECT during this pharm stress study.

PET MPI Report

The PET images demonstrate the above-described apical scar pattern but also demonstrate a mild to moderate anterior ischemic pattern involving the distal half of the anterior segment. This is suggestive of mild peri-infarct ischemia. The LV ejection fraction in the PET study is 53% at rest rising to 57% with pharmacologic stress (normal left ventricular function). Statistically, the likelihood of a perioperative event is still fairly low.

Note: Even though this patient received pre-op clearance for hip surgery, the detection of ischemia on the PET study provided prognostically useful information to assist in the management of this patient’s progressive CAD.

Reference: Case study courtesy of Medical Imaging & Technology Alliance ( The report was prepared by Dr. Jim O’Donnell at University Hospitals Case Medical Center, Cleveland, OH.

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