Educational Resources

Tc-99m SPECT VS Rubidium-82 PET

Case Report No. 1

A Tc-99m SPECT Rest and Stress scan was performed on an 80 year old female with a positive exercise treadmill test. A dose of 1375 MBq (37 mCi) was used for the Stress portion of the scan.

Interpretation: LAD ischemia or potential artifact causing a false positive.

The patient was referred to PET for a Rest and Stress Rb-82 scan a few weeks following the initial Tc-99m SPECT scan.

Interpretation of the Rb-82 PET scan revealed moderate LAD ischemia and LCX ischemia. The results of the PET scan revealed additional areas and degree of ischemia compared to the SPECT scan.

Images courtesy of Ottawa Heart Institute, Ottawa, ON, Canada

Case Report No. 2

A Tc-99m SPECT Rest and Stress scan was performed on an 58 year old female with atypical chest pain.

Interpretation: Mild reversible defect in anterior wall and apex suggestive of ischemia in the LAD territory.

Circ J 2013; 77:839

A Rb-82 PET rest and stress scan was performed.

Interpretation: Normal perfusion.

Outcome: Patient did not require invasive coronary angiography.

Case Report No. 3

A Tc-99m SPECT Rest and Stress scan was performed on an 79 year old male with atypical chest pain.

Interpretation: Moderate to severe defects at rest and stress in the RCA territory and apex indicating non-transmural scar without ischemia.

Circ J 2013; 77:839

A Rb-82 PET rest and stress scan was performed.

Interpretation: Defects at stress with resolution at rest indicate ischemia in the RCA ± LCX. Coronary angiography demonstrated a total occlusion in the mid RCA, 90% stenosis in the LCX, luminal irregularities in the left main and 40% stenosis in the LAD.

Outcome: PET demonstrated superior sensitivity for the detection of significant CAD in comparison with SPECT.