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Incremental Value of Assessment of Regional Wall Motion for Detection of Multivessel Coronary Artery Disease in Exercise 201Tl Gated Myocardial Perfusion Imaging

Naoya Shirai, MD;1, Hiroyuki Yamagishi, MD;1, Minoru Yoshiyama, MD;1, Masakazu Teragaki, MD;1, Kaname Akioka, MD;1, Kazuhide Takeuchi, MD;1, Junichi Yoshikawa, MD;1 and Hironobu Ochi, MD2

1 Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
2 Department of Nuclear Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan



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FIGURE 1. Relationship between short-axis tomographic segments and coronary arterial territories (A) and schema of 9 segments of left ventricle on 3-dimensional cine-mode display created with automatic left ventricular function analysis software program for ECG-gated myocardial perfusion SPECT (B). Reversible perfusion defects and worsening of wall motion in anterior, septal, and apical segments represented disease in left anterior descending artery (LAD), those in inferior segments represented disease in right coronary artery (RCA), and those in lateral segments represented disease in left circumflex artery (LCX). 1 = basal anterior; 2 = middle anterior; 3 = apex; 4 = middle inferior; 5 = basal inferior; 6b = basal septum; 6m = middle septum; 7b = basal lateral; 7m = middle lateral.

 


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FIGURE 2. Sensitivity, specificity, and accuracy in identification of multivessel CAD. *P < 0.05 compared with reversible perfusion defect alone.

 


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FIGURE 3. Representative images of tomograms from 57-y-old woman with 50% stenosis of left main coronary artery and no significant stenosis in right coronary artery. She had previous inferior myocardial infarction, which had been treated with placement of coronary stent in right coronary artery. Tomographic images revealed fixed defect in inferior wall.

 


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FIGURE 4. Left ventricular functional images obtained by ECG-gated myocardial SPECT from same patient as in Figure 3. Outer cage and solid surface represent endocardial surfaces at end-diastole and end-systole, respectively. In initial images, anteroapical wall, septum, and lateral wall were hypokinetic and inferior wall was akinetic. In reinjection images, anteroapical wall, septum, and lateral wall were normokinetic and inferior wall was akinetic. Worsening of regional wall motion was observed in anteroapical wall, septum, and lateral wall. These findings suggested left anterior descending artery disease and left circumflex artery disease.

 





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