title: Duodenogastric reflux on (99m)Tc-tetrofosmin myocardial SPECT mimics left ventricle inferior wall reverse redistribution and falsely decreases ejection fraction: a case report.
abstract: 99mTc-labeled myocardial perfusion agents are excreted through the hepatobiliary system and can be used in the evaluation of the duodenogastric reflux that occurs during routine cardiac imaging. The resultant gastric activity can overlap the inferior wall of the left ventricle (LV) and can thus mimic reverse redistribution of the LV inferior wall on dual-isotope SPECT. We report a case of significant gastric activity, which leads to abnormally low LV ejection fraction and akinesis of the LV wall in addition to the appearance of reverse redistribution. This case report illustrates that care should be taken in the performance and interpretation of (99m)Tc-tetrofosmin SPECT in the presence of duodenal reflux. This condition could be mistaken for reverse redistribution in the inferior wall of the LV with concomitant underestimation of the LV and regional wall motion.
authors.affiliation: Section of Cardiology, Medicine Service, and Nuclear Medicine Service, Lexington VA Medical Center, Lexington, KY 40511, USA.
authors.forename: P
authors.initials: P
authors.lastname: Donovan
authors.forename: V
authors.initials: V
authors.lastname: Kieffer
authors.forename: W J
authors.initials: WJ
authors.lastname: Shih
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004383:Duodenogastric Reflux / Q000000981:diagnostic imaging*; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013318:Stroke Volume; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C027549:thallium chloride; C078700:technetium tc-99m tetrofosmin; D013793:Thallium