A 66-year-old woman with risk factors for cardiovascular disease underwent a PET/CT stress test which showed strongly positive results. The test revealed a large, totally reversible perfusion defect in the anterior wall, apex, and septum consistent with moderate-severe ischemia in the LAD territory. Left ventricular function was normal at rest but dropped significantly with stress, and myocardial flow reserve was reduced globally with evidence of steal phenomenon in the LAD territory. Coronary calcium scoring and other PET/CT findings were indicative of high cardiac risk. The patient was found to have severe coronary artery disease on subsequent cardiac catheterization.

1. Learning case of strongly positive PET/CT Rubidium 82 on all parameters
I. Suliman (King Abdulaziz Cardiac Center, National Guard Hospital , Riyadh, Riyadh, Saudi Arabia)
Introduction:
66 years old lady married with grown up children (BMI
30.02kg/m² BSA 1.80m²) with DM, HTN, DLP, CVA and
atypical CP referred for PET /CT stress test.
Base line ECG
Stress ECG
Take home message:
PET/CT stress test is a very useful test
to detect and quantify myocardial
ischemia
PET /CT Impression:
• Abnormal study. High risk study.
• Regadenoson-ECG: Positive for ischemia by ST
criteria. No chest pain. No arrhythmia.
• Perfusion: There is a large area of moderate
totally reversible perfusion defect in the mid to
apical segments of the anterior wall, apex, and
apical segments of the septum, inferior and lateral
walls. This is consistent with moderate-severe
ischemia in the LAD territory. Total Ischemic
Myocardium: 23.53%
• LV Function: Normal LV size and systolic
function (stress EF= 54%, Rest EF= 70%).
Stress-induced anterior wall and apical
hypokinesia. There was significant drop in stress
EF as compared to rest (16 points).
• Reduced global myocardial flow reserve with
steal phenomenon in the LAD territory.
• Coronary calcium score is 106 which is 50-75th
percentile for age/gender matched cohort.
• TID is high at 1.39.
Cardiac Catheterization showed severe CAD.
Disclosure: No thing to disclose.