Multiple Choice Question of the Week : Nuclear-07 : [Answer]

             
      


67 year-old man, with previous MI
Recent onset of effort dyspnoea
ECG: inferior MI, VEB
Echo: poor acoustic window. EF: 35%
Waiting list for hip replacement

Which kind of tracer/s   is/are used?
Which is the best interpretation of these images?

A) rest 201Thallium/ stress 99mTc Tetrofosmine, area of necrosis plus ischemia
B) 99mTc Tetrofosmine stress/rest study, area of necrosis plus ischemia
C) 99mTc Tetrofosmine/123I MIBG perfusion-innervation mismatch for the evaluation of EV area
D) 99mTc Tetrofosmine with and without nitrates study for the evaluation of viability

Right answer is: C) 99mTc Tetrofosmine/123I MIBG perfusion-innervation mismatch for the evaluation of EV area

Regional impairment of left ventricular (LV) sympathetic innervation, as evaluated at tomographic 123 I-MIBG imaging, has been demonstrated predicting adverse clinical events in patients with ventricular arrhythmias (VA)
In patients with VA submitted to EAM, successful ablation sites have been shown to co-localize at the level of perfusion/innervations mismatch, characterized by viable myocardial regions but impaired sympathetic innervations, which may represent possible targets during ablation

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