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Reverse Redistribution on Dynamic Exercise and Dipyridamole Stress Technetium-99m-MIBI Myocardial SPECT

Nuclear Medicine and Cardiology Services, Department of Veteran Affairs Medical Center and University of Kentucky Medical Center, Lexington, Kentucky

Correspondence: For correspondence or reprints contact: Wei-Jen Shih, MD, Nuclear Medicine Service, VA Medical Center, Lexington, KY, 40511.

ABSTRACT

Reverse redistribution on ²⁰¹Tl-chloride stress-redistribution myocardial scintigraphy has been associated with coronary artery stenosis. We report a patient whose two separate ^99mTc-MIBI myocardial SPECT stress studies (dynamic exercise and dipyridamole) showed septal reverse redistribution and fixed inferior defect. Echocardiograms showed left ventricular (LV) hypertrophy and diffuse hypokinesis, especially in the inferior wall, and EKG showed LV hypertrophy and strain and inferior infarct. Coronary angiogram confirmed two-vessel disease in volving 80%-90% stenosis of the proximal second diagonal branch of the left anterior descending artery and 75%-90% stenosis of the right coronary artery as well as global left ventricular dysfunction. Reverse redistribution on ^99mTc-MIBI myocardial SPECT occurring on dynamic or dipyridamole stress may indicate damaged but viable myocardium.

Key Words: reverse redistribution • technetium-99m-MIBI • dipyridamole stress testing • single-photon emission computed tomography