MCQ : Nuclear-20
68 yo pt with new onset of effort dyspnoea. Previous inferior MI. He was submitted to stress/rest SPECT.
Which is the best interpretation of these images?
A) Necrosis in RCA territory
B) Necrosis in RCA and ischemia in LCxterritory
C) Necrosis in LCx and ischemia in RCA territory
D) Necrosis in RCA and LCx territories
Correct Answer is D) : Necrosis in RCA and LCx territories
The pts was submitted to single day dipyridamole/rest CZT scan. Baseline ECG showed q waves in DII, DIII and aVF. No abnormalities at peak stress.
The images showed a a fixed defect indicative of infarction without reversibility to suggest classical stress-related ischemia.
Gated images indicated akinesia of inferior wall, lateral wall and apex. Rest EF: 38%, stress 35%.
MRI confirmed the absence of viability in the same territories.
The invasive coronary anatomy showed chronic proximal occlusion of LCx (dominant) with hypoplasia of RCA.
