GE Healthcare

SPECT/CT and CardIQ Fusion guide

therapy decisions for physicians
Dominique Delbeke, M.D., Ph.D.
Professor and Director of Nuclear Medicine/PET
Department of Radiology and Radiological Sciences
Vanderbilt University Medical Center

Overview
Due to an extensive history of coronary artery disease (CAD),
the patient was referred for a SPECT/CT scan to correlate
cardiac anatomy and physiology.

Patient History
65 year-old female with known CAD, hypertension and
hyperlipidemia. Presented with new angina.

Methods
Resting SPECT images were acquired after an injection of
13.7 mCi of Tc-99m Tetrofosmin (Myoview). After reaching
peak exercise on a treadmill, the patient was injected with
40.2 mCi of Tc-99m Tetrofosmin (Myoview). SPECT images were Figure 1. Perfusion defect in the
inferiolateral wall
acquired on a VentriTM nuclear camera, while the CT scans
were taken on a LightSpeedTM 64 VCT scanner.

The patient presented to her study with a heart rate of

50 bpm while on oral beta blockage medication. Using
contrast, LightSpeed VCT images were obtained in multiple
phases of the cardiac cycle.

Findings
The gated, post-stress and resting images revealed normal
wall motion with a left ventricular ejection fraction of greater
than 65 percent and a normal end diastolic volume at 45 ml.
All SPECT images were viewed and measurements were
generated using Myovation on the Xeleris 2 workstation.
Overall impression of the study is clinically normal for
Figure 2. Standard polar plot overlays, as
ischemia, but scintigraphically positive for ischemia.
this one shown on Myovation, point to the
LCX as the coronary artery suspected of
causing ischemia

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All CT and CardIQ Fusion images were processed and viewed
on an AW VolumeShare 4.2 workstation.

RCA - Right coronary system is dominant. Advanced

diffuse calcific stenosis and short segments of occlusions.
Reconstitution of a patent crux and prominent PDA and PLB
from retrograde transseptal LAD collaterals. CardIQ Fusion
shows a perfusion defect in the inferior and lateral wall
generated by the advanced diffuse stenosis in the RCA.
Left main and LAD - Patent proximal stent. Irregular inlet
portion of stent, in-stent stenosis cannot be excluded.
Possible distal apical LAD occlusion. CardIQ Fusion shows
normal perfusion in the anterior wall consistent with the Figure 3. Patent LAD stent leading to good
patent LAD stent. perfusion in the anterior-lateral walls

LCX - Anomalous retroaortic small circumflex artery arises

from the right coronary cusp adjacent to the RCA ostia
takeoff. Stenotic segments of its very proximal portion
followed by continuing patent retroaortic course towards
the proximal A-V circumflex groove, terminating in a small
obtuse marginal branch.

Clinical and Patient Advantages

CardIQ Fusion allows physicians to visualize physiological
data such as perfusion and viability from SPECT images,
while reviewing anatomic assessments of the CT such as
vessel analysis and stenosis detection and quantification.
Figure 4. CTA shows patent anomalous
In this case, the CardIQ Fusion images illustrate the diffuse
LCX grows from right coronary tree
calcific stenosis and short segments of occlusion in the
dominant RCA are responsible for the ischemia of the inferior
and lateral wall. The normal anterior wall SPECT perfusion
correlate well with the patent stent in the LAD.
Dr. Delbeke stated, If the patient had only a myocardial
perfusion scan, this patient would have been sent to cath.
Cath has limitations to depict the course of anomalous
vessels such as the LCX in this case. If CTA would have been
performed first, myocardial perfusion imaging would have
been considered to assess the functional impact of the lesions.
Both together helped to identify the vessel responsible for
symptoms and guide therapy.
Figure 5. CardIQ Fusion aids the physician
to visualize that the RCA is responsible for
the perfusion defects seen in the Myoview
SPECT exam

GE Healthcare 2007 General Electric Company All rights reserved.

GE and GE Monogram are trademarks of
3000 North Grandview Blvd General Electric Company.

Waukesha, WI 53188 Myoview, Ventri, LightSpeed, Myovation, AW VolumeShare,

Xeleris and CardIQ are trademarks of GE Healthcare.
U.S.A.
General Electric Company, doing business as
www.gehealthcare.com GE Healthcare.

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NU-0150-07.07-EN-US