Reversible perfusion pattern in hypertrophied papillary muscles evident on myocardial perfusion imaging with CZT-based c
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Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India Department of Radiology and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Received Jul 9, 2020; accepted Aug 7, 2020 doi:10.1007/s12350-020-02333-8
INTRODUCTION Identification of ischemia in the papillary muscle in routine stress/rest myocardial perfusion scintigraphy is less explored and documented entity owing to varied reasons. Normally thinned out PMs are beyond the resolution of the SPECT/CT gamma camera and are less often appreciated, unless hypertrophied. Scintigraphic recognition and localization of PM in MPI are described before in the literature both in SPECT as well as myocardial PET, but owing to rarity of presentation and limitation in spatial resolution affecting reliable visualization, comment on PM ischemia did not incorporate in the routine MPI reporting.1–4 The emergence of cadmium-zinc-telluride (CZT) detector-based cardiacspecific camera with enhanced spatial and energy resolution has greatly increased the sensitivity of
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02333-8) contains supplementary material, which is available to authorized users. The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. Reprint requests: Ashwani Sood, DNB, Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh 160012, India; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
detection of myocardial perfusion defects.5 This study describes reversible myocardial perfusion pattern observed in the hypertrophied PM in a group of six patients in whom stress-rest MPI was done in CZTbased cardiac-specific gamma camera. METHODS Recently we reported SPECT MPI finding of reversible perfusion defect in PM in a long-standing hypertensive patient with hypertrophy of PM.6 We analyzed the stress-rest MPI studies done to assess inducible ischemia in myocardium with cadmium-zinctelluride (CZT) detector-based cardiac-specific gamma camera (D-SPECT, Spectrum Dynamics, Palo Alto, USA) within the last 16 months. We identified six patients fitting into the pattern of reversible perfusion defect in the PM (relative increase in the tracer uptake in the region of PM in left ventricular cavity in rest images compared to the stress images). All the patients underwent a one-day adenosine stress/rest 99mTc-sestamibi gated SPECT MPI, except in one patient in whom 2-day stress/rest protocol was used. Pharmacological stress with adenosine infusion (140 lgkgmin, 6-minute infusion, and tracer injection at 3 minutes) was done in four
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