Case Author(s): Jayson R. St. Jacques,M.D. and Robert J. Gropler,M.D. , . Rating: #D3, #Q3
Diagnosis: Cardiac Viability Evaluation
Brief history:
57 year old man with history of coronary artery disease.
Images:
Thallium rest and delayed redistribution images.
View main image(mi) in a separate image viewer
Full history/Diagnosis is available below
Diagnosis: Cardiac Viability Evaluation
Full history:
57 year old man with a history of diabetes, coronary artery disease, and renal failure on hemodialysis.
Cardiac catherization from previous day demonstrated significant triple vessel disease with at least 75-80% left anterior descending disease, 90% diagonal, 90% circumflex, and 100% right coronary artery disease.
Cardiac viability examination requested prior to coronary bypass surgery.
Radiopharmaceutical:
3.6 mCi Thallium-201 chloride i.v.
Findings:
Rest and redistribution thallium myocardial images demonstrate viable septum, anterior wall, and distal lateral wall. There is a mixture of viable and non-viable tissue in the apex and inferolateral walls and a non-viable posterolateral wall. Resting left ventricular cavity enlargement is present.
Followup:
Echocardiography performed 5 days later demonstated dilated left ventricle with inferior akinesis and hypokinesis of the posterior, septal, and anteroseptal walls.
The patient underwent coronary artery bypass surgery with saphenous vein graph times three and also a left internal mammary arterial graph.
Major teaching point(s):
When interpreting these studies some important points are:
1. Patterns of viable myocardium include:
Preserved MBF on initial images (delayed images irrelevant)
Reduced MBF with redistribution
2. Persistent defect indicative of nonviable tissue
3. Report as a continuum not cut-offs
4. In conclusion use terms such as predominantly viable or nonviable myocardium and report extent of viable and non-viable tissue
ACR Codes and Keywords:
References and General Discussion of Myocardial Imaging (Anatomic field:Heart and Great Vessels, Category:Organ specific)
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Case number: mi022
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