Regional 18F-FDG uptake indicates coronary artery anomaly in a middle-aged patient with no atherosclerosis risk.
Regional 18F-FDG uptake indicates coronary artery anomaly in a middle-aged patient with no atherosclerosis risk.
复制标题
局部 18F-FDG 摄取表明中年患者存在冠状动脉异常，无动脉粥样硬化风险。
DOI：
10.1007/s12350-019-01672-5
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Nishiyama Y.
中科院分区：
文献类型：
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作者：
Norikane T;Ihara A;Yamamoto Y;Takami Y;Mitamura K;Tanaka K;Arai-Okuda H;Nishiyama Y.
18F-氟脱氧葡萄糖（FDG）不仅在恶性病变和炎性病变中蓄积，而且在缺血心肌中蓄积。我们报告一位41岁无动脉硬化风险的女性，在体格检查时发现异常心电图，而超音波检查发现左心室壁运动异常。心电图显示窦性心律，V1-V3导联为QS模式，I、aVL和V3-V6导联ST段下移。超声心动图显示前壁、间隔壁和心尖部严重运动功能减退。最初，她被怀疑患有心脏结节病，然后进行了18F-FDG正电子发射断层扫描（PET）/计算机断层扫描（CT）。她在18F-FDG PET/CT扫描前禁食超过12小时。基础短轴18 F-FDG PET图像（图1A）、融合的18 F-FDG PET/CT图像（图1 B）和使用18 F-FDG的牛眼图像（图1C）显示在左心室的间隔壁、前壁和侧壁中弥漫性增加的摄取。基础短轴CT图像显示左心室前壁和前外侧壁内膜下脂肪沉积（图1D）。根据18F-FDG PET/CT结果怀疑缺血性心肌病。进行冠状动脉CT扫描和201 Tl心脏单光子发射计算机断层扫描（SPECT）。CT图像显示左冠状动脉起源于右瓣尖（图2A）。左冠状动脉穿过主动脉和肺动脉之间的路线，在该位置观察到动脉狭窄（图2 A和B，箭头）。SPECT和定量灌注SPECT（QPS）图像显示左冠状动脉分布区存在小的不可逆缺损和大的可逆缺损（图3）。她最后被诊断为起源于右冠状动脉尖的异常左冠状动脉。大多数先天性冠状动脉异常似乎没有临床意义。然而，在主动脉和主肺动脉之间存在动脉间病变的冠状动脉异常可能导致更高的心绞痛、心肌梗死和猝死发生率。18F-FDG在缺血心肌中蓄积。1一些病例报告注意到，在患有冠状动脉疾病的肿瘤患者中偶然观察到心肌局灶性异常18F-FDG摄取。2，3即使在局部和局灶性积聚的情况下，似乎也需要检查冠状动脉。
18F-fluorodeoxyglucose (FDG) accumulates not only in malignant and inflammatory lesions but also in ischemic myocardium. We present a 41-year-old female with no atherosclerosis risk who showed an abnormal electrocardiogram (ECG) during a physical examination and abnormal wall motion in the left ventricle on echocardiography. The ECG showed sinus rhythm, QS pattern in lead V1-V3, and downsloping ST segment depressions in lead I, aVL, and V3-V6. The echocardiogram showed severe hypokinesis of the anterior wall, septal wall, and apex. Initially, she was suspected of having cardiac sarcoidosis and then 18F-FDG positron emission tomography (PET)/computed tomography (CT) was performed. She fasted for over 12 hours before the 18F-FDG PET/CT scan. Basal short-axis 18F-FDG PET image (Figure 1 A), fused 18F-FDG PET/CT image (Figure 1 B) and bull’s eye image using 18F-FDG (Figure 1 C) showed diffusely increased uptake in the septal, anterior, and lateral walls of the left ventricle. Basal short-axis CT image revealed subendocardial fat deposition in the anterior and anterolateral wall of the left ventricle (Figure 1 D). Ischemic cardiomyopathy was suspected from the 18F-FDG PET/CT findings. Coronary CT scan and stress/redistribution 201Tl cardiac singlephoton emission computed tomography (SPECT) were performed. CT image showed that the left coronary artery arose from the right cusp (Figure 2 A). Left coronary artery traversed a course between the aorta and pulmonary artery, and artery stenosis was observed at this location (Figures 2 A and B, arrows). SPECT and quantitative perfusion SPECT (QPS) images demonstrated a small irreversible defect and large reversible defect in the left coronary artery distribution region (Figure 3). She was finally diagnosed with anomalous left coronary artery originating from the right coronary cusp.Most congenital coronary artery anomalies appear to be of no clinical significance. However, coronary artery anomalies with an interarterial course, between the aorta and the main pulmonary artery, are likely to result in a higher incidence of angina, myocardial infarction, and sudden death. 18F-FDG accumulates in ischemic myocardium. 1 Some case reports have noted incidentally observed focal abnormal 18F-FDG uptake in myocardium in oncologic patients with coronary artery disease. 2, 3 Even in the case of regional, as well as focal, accumulation, examination of the coronary artery seemed to be required.