Clinical Presentation

A 68-year-old woman presents with a 1-week history of exertional chest pain and shortness of breath. She is found to have heart failure, with an ejection fraction of 20%. The troponin level is elevated to 0.16 ng/mL, with lateral T-wave inversions on ECG. She is referred for PET to assess for myocardial viability and potential coronary revascularization.

Fig. 43.1

• The patient had nothing to eat within 4 hours of the test.

• After a scout CT acquisition (120 kVp, 10 mA) for patient positioning, a CT transmission scan (140 kVp, 30 mA, pitch of 1.35) was acquired for attenuation correction. Commercial software was used for coregistration of the transmission and emission images.

• The patient underwent a rest myocardial perfusion PET study. Rest emission images were obtained after the intravenous administration of 60 mCi of ⁸²Rb, with imaging starting at 120 seconds (given the low ejection fraction) after completion of the radionuclide infusion and continued for 5 minutes. Rest gated images were acquired at 8 frames per cycle.

• PET images were reconstructed with ordered subsets expectation maximization (OSEM; 2 iterations and 30 subsets), and a three-dimensional PET filter was used (Butterworth filter cutoff frequency of 10, order of 5).

• After the rest image acquisition, the patient received 25 g of oral Trutol (glucose tolerance beverage) and a total of 9 U of regular insulin intravenously to optimize myocardial utilization of glucose.