Special Cases

Reverse Changes

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Impression:

  • Moderate reduced uptake in the inferior wall and posterior septum at rest (arrows) -- consistent with nontransmural MI (7/25 segments) (RCA territory). No stress-induced ischemia.
  • Notice increased extracardiac activity (liver, arrows with "L") in the rest images.
    The maximum cts/pixel in the liver is equal to but not higher than the maximum cts/pixel in the myocardium, dataset is therefore normalized to the portion of the myocardium with the highest uptake.
  • Reverse changes in the inferior segment and posterior septum (small lines) confirmed by quantification (bullseye images).

    Comment:
    Reverse change (defined as higher relative uptake in a given segment at stress compare with rest) is considered a sign of myocardial injury in an area supplied by a patent coronary artery or sufficient collateral system. It is a good sign.

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    Atlas of Myocardial Perfusion SPECT
    © Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    Comments and errors to atlasspect@yahoo.com
    Contributions and case related information through     Fmannting@bics.bwh.harvard.edu

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    Initiated: Nov 19, 1995. Last updated: April 26, 1999.