Case Report: Multivessel Coronary Disease Assessment With Spect Tc-99m-Sestamibi And Rubidium-82 Pet/Ct

Coronary angiography (CAG) is the standard diagnostic method for detection of coronary artery disease (CAD). However, it is often necessary to evaluate the expression of a coronary obstruction in relation to myocardial perfusion, before defining the best patient management.Myocardial perfusion scintigraphy with technetium-99m-Sestamibi (99mTc-sestamibi) allows early detection and evaluation of disease extension and cardiovascular risk in patients with suspected or established CAD, helping in decision-making regarding the start and type of therapy to be implemented.1 This method has been widely used, but shows difficulties in some situations such as balanced multivessel disease, in which the proportional flow distribution in the myocardial regions can hinder ischemia detection. In such cases, additional assessment data, such as evaluation of contractility, decrease in left ventricular ejection fraction (LVEF) under stress, electrocardiographic alterations or symptoms during stress, dilation of the left ventricle (LV) cavity under stress can provide evidence of ischemia, indicating further diagnostic investigation.Noninvasive imaging using Positron-Emission Computed Tomography (PET-CT) allows the acquisition of myocardial perfusion imaging with better quality than conventional equipment, in addition to estimating quantitative measures of myocardial blood flow at rest and under stress, as well as of coronary reserve.We report the case of a patient with multivessel CAD referred for evaluation of myocardial perfusion, which was carried out through the two methods (Figure 1).Figure 1A) Myocardial perfusion at rest (R) and stress (S) with technetium-99m-Sestamibi (MIBI) to the right and rubidium-82 (82Rb) to the left. Ischemia can be observed in most prominent inferolateral wall in 82Rb. B) Left ventricular motility study (GATED-PET) ...