MCQ : Nuclear-22
Rest Rb PET and FDG PET
66 year old male with history of CAD and total occlusion of the mid-LAD
Your Recommend:
A) Dobutamine Echocardiography for higher sensitivity
B) Medical therapy alone since the LAD territory is scared
C) Revascularization in addition to guideline directed medical therapy
D) We need stress Rb-PET images to prove ischemia before recommending revascularization
Correct Answer is C) : Revascularization in addition to guideline directed medical therapy
There is evidence of a large perfusion defect seen on the Rb images (Top). In addition, in the area of this perfusion defect, there is evidence of intense FDG uptake indicating perfusion-metabolism mismatch or hibernation.
Dobutamine echo is more specific for recovery of LV function when assessing for hibernation but not more sensitive.
Given the proven large amount of myocardium at risk (hibernating myocardium), there is no need for stress Rb PET in this patient.
