Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT
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Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT Minkyung Lee & Jeong Ho Kim & Minki Yoon & Kyung Hoon Hwang & In-Suck Choi & Soo Jin Choi & Wonsick Choe
Received: 22 November 2009 / Accepted: 25 January 2010 / Published online: 21 April 2010 # Korean Society of Nuclear Medicine 2010
Abstract The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EKG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.
Keywords Reverse redistribution . Myocardial perfusion imaging . 64-slice multidetector-row CT . Subendocardial MI
M. Lee : K. H. Hwang : W. Choe Department of Nuclear Medicine, Gachon University Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, South Korea J. H. Kim : S. J. Choi Department of Radiology, Gachon University Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, South Korea I.-S. Choi Division of Cardiology, Gachon University Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, South Korea M. Yoon Department of Nuclear Medicine, Good Samaritan Hospital, Pohang, South Korea Present Address: W. Choe (*) Department of Nuclear Medicine, Kangbuk Samsung Hospital, 108 Pyung-dong, Jongro-gu, Seoul 110-746, Korea e-mail: [email protected], [email protected]
Fig. 1 The patient was a 49-year-old man with a 1-year history of diabetes mellitus and hypertension, who was admitted with chest pain and ventricular fibrillation to rule out an acute myocardial infarction (MI). CK-MB and troponin were abnormally elevated. The electrocardiogram (EKG) after DC cardioversion shows prominent ST elevation in leads II, III, aVF, and V5–6, findings suggestive for subendocardial MI in the inferior wall. A coronary angiogram showed a total occlusion of the distal left circumflex artery (LCX). A followup EKG showed no Q-wave
Nucl Med Mol Imaging (2010) 44:154–156
Fig. 2 Myocardial perfusion imaging shows a large moderate perfusion defect in the mid-to-basal inferior and inferolateral regions on the rest images, which, on the later 24-h delayed images, increases in extent and severity of the defect to be absent in some areas (arrow). This is a reverse redistribution (RR). RR was defined as the
Fig. 3 Sixty-four-slice multidetector-row computed tomography (MDCT) short-axis views of the middle left ventricle show a perfusion defect (arrows) at early phase (20–40 s after contrast injection) and delayed enhancement (arrowheads) at late phase (after 5 min after contrast-injection) in the subendocardial area of the inferior and inferolateral segments. These findings are suggestive of subendocardial MI
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appearance of a defect on the redistribution image in a region with normal
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