SPECT 2

NMED 475 – Molecular SPECT Imaging

Journal Article Review

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Name of article

De Lorenzo, A., da Cruz Netto, P. G., & Pedras, P. D. S. V. (2016). Incidental Liver Findings in 99mTc-Sestamibi Myocardial Perfusion SPECT. Journal of nuclear medicine technology, 44(1), 42-43.

Section I: Introduction/Background

The use of the nuclear techniques in the binary disorders diagnosis has remained popular in nuclear medicine. Nuclear imaging especially of the binary system is being applied in different cases. For example, in making a hepatic image in the myocardial perfusion SPECT which is considered as the common artifact source. The myocardial perfusion SPECT creates false perfusion defects, especially in the ventricular inferior wall. The bio-distribution helps in detecting the incidental hepatobiliary abnormalities. The liver has been considered as the major artifact source in the inferior wall of the left ventricular during cardiac nuclear imaging. In the imaging process, the significant non-cardiac disease can be brought to attention especially the moment liver displays unexpected findings.

Section II: summary

The article involves a case report about a typical chest pain in a woman aged 63 years. The woman was referred for a myocardial perfusion SPECT. She had suffered severe hypertriglyceridemia and underwent pancreas surgical intervention. The woman failed to ensure a follow up after the abdominal intervention. A study on myocardial perfusion of rest–dipyridamole stress was conducted where a dual head camera was used to obtain images. Approximately 30 minutes after the tracer injection, the rest acquisition began. The postdypiridamole images were also obtained after injections approximately 45 minutes later. The findings showed that there were some areas that had focal uptake increased in the liver after stress and at rest. The case makes myocardial perfusion to be considered as normal with anteroapical perfusion defect that is mild. In nuclear medicine interpretation, this can be considered as a breast attenuation in the wall motion and normal thickening view.

A nuclear scan was done in the process of conducting a further investigation concerning liver abnormalities. The scan involved abdominal CT scanning of the patient. The nuclear scan showed multiple intrahepatic of biliary tract dilatations. The bile stasis in the biliary tract dilatations was attributed to the increased tracer uptake focal areas in scintigraphic images. The woman was taken through surgical follow up that was specialized. After the laboratory evaluations, serum bilirubin values were found at within a reference range. This can be attributed to the fact that the patient was still stable based on the hepatobiliary condition hence no further intervention was recommended. However, the women needed admission for the glycemic control due to the severe hyperglycemia despite the insulin domiciliary utilization.

Section III: Interpretation of article

The authors seem to express the need for carefulness in the analysis of the myocardial perfusion scintigraphy. Also, the authors used the extracardiac results in the article in communicating the serious subclinical disease. The article helps in showing how biliary abnormalities can be detected in nuclear medicine. For example, the Tc-sestamibi biodistribution has been used in the case to detect the biliary abnormalities. This was possible as the biliary system tracer excretion takes place the moment there is a decline in Tc-sestamibi uptake by the liver.

Section IV: Opinion of article

In my opinion, the moment a patient is taken for myocardial perfusion SPECT when atypical chest pain is being investigated the high tracer uptake focal areas shows intrahepatic biliary dilatation. Also, based on this article, I think nuclear imaging can sometimes uncover relevant pathology hence during cardiac nuclear imaging carefulness is necessary. However, diagnosing the disease early can be important as it can minimize its effects on the patient and clinical interventions can be taken at the right time.

Copy of the article

This is the article link: http://tech.snmjournals.org/content/44/1/42.full

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