title: Underestimation of regional myocardial perfusion with Tc-99m sestamibi single-day rest-stress SPECT: a "drug washout" pitfall?
abstract: Myocardial perfusion scintigraphy with a Tc-99m sestamibi single-day SPECT protocol is a widely used technique to examine patients with possible or known coronary artery disease. A 76-year-old man with a clinical history suggestive of ischemic heart disease underwent Tc-99m sestamibi myocardial SPECT imaging with a same-day rest and stress protocol after temporary discontinuation of his current therapy, which included calcium channel and beta blockers and nitrates. The scintigraphic pattern was consistent with an asymptomatic infarction of the posterolateral myocardial wall and periinfarct ischemia. One week later, the patient had a Tc-99m sestamibi myocardial SPECT study at rest without discontinuing therapy, and scintigraphic images showed normalization of the posterolateral wall perfusion defect. The angiographic study showed a 90% stenosis of the circumflex artery. This case suggests that, during a 1-day cardiac SPECT protocol, washout of therapeutic pharmaceuticals may be responsible for underestimation of myocardial rest perfusion in territory supplied by a coronary artery with a critical stenosis.
authors.affiliation: Section of Nuclear Medicine, University of Ferrara, Italy. C.Cittanti@unife.it
authors.forename: C
authors.initials: C
authors.lastname: Cittanti
authors.forename: D
authors.initials: D
authors.lastname: Mele
authors.forename: P
authors.initials: P
authors.lastname: Colamussi
authors.forename: M
authors.initials: M
authors.lastname: Giganti
authors.forename: E
authors.initials: E
authors.lastname: Ricci
authors.forename: A
authors.initials: A
authors.lastname: Dafermou
authors.forename: L
authors.initials: L
authors.lastname: Uccelli
authors.forename: A
authors.initials: A
authors.lastname: Piffanelli
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D017256:Technetium Tc 99m Sestamibi