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

Findings

SPECT MPI Report

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 (http://www.medicalimaging.org/about-mita/detail-kits/). The report was prepared by Dr. Jim O’Donnell at University Hospitals Case Medical Center, Cleveland, OH.