Clinical History
This is a 60-year-old female with extensive anteroseptal apical defect on her myocardial perfusion imaging scan. The cardiac catheter evaluation shows occluded LAD. This exam is ordered with the need to know if there is viable myocardium that might respond to a CABG.
Technique
The patient ate one hour prior to the injection and her blood glucose level was 291. The patient received an intravenous injection of 10.0 millicuries of F18 FDG, and 45 minutes later imaging of the myocardium was attempted, however, no myocardial uptake was seen. After waiting an additional 60 minutes, the myocardium showed uptake of the FDG radiotracer. It is presumed that due to the patient's high blood glucose level, the patient initially was consuming triglycerides rather than glucose. By waiting an additional hour the body began consuming glucose rather than triglycerides, thereby allowing for visualization of the myocardium. Initially the randoms out-numbered the trues by 2:1 and after 60 minutes, the trues then out-numbered the randoms by 2:1.
Findings
There is a moderate decrease in activity in the septal half of the extreme apex with more focal concentration in the anterior septum in the apical half of the heart. The inferior septum and anterolateral wall show normal glucose metabolism with the brightest regions being in the septum in the mid ventricle. The inferior wall of the heart also appears normal, but of less intensity than the septum or anterior septum. The brightest region of interest in the septal portion of the heart measures 743 with the activity in the anterior septum and anterior wall in the apex being no lower than 399 or a ratio of 53.70 at the lowest.
Impression:
THERE IS DECREASED GLUCOSE METABOLISM IN THE SEPTAL HALF OF THE EXTREME APEX AS WELL AS LIMITED TO THE ANTERIOR SEPTUM IN THE APICAL HALF OF THE HEART. THE REST OF THE MYOCARDIUM SHOWS NORMAL GLUCOSE METABOLISM. THE AREA IN QUESTION AT THE LOWEST SHOWS A RATIO OF AFFECTED MYOCARDIUM TO MAXIMUM ACTIVITY IN THE HEART OF NO LESS THAN 53%. THIS WOULD SUGGEST VIABLE MYOCARDIUM WITH A REASONABLY GOOD PROGNOSIS OF RECOVERY WITH REVASCULARIZATION.
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