We present the case of a 62-year-old man with colorectal carcinoma with unusual segmental myocardial 18F-FDG uptake. PET/CT scan was requested for evaluating response to chemotherapy before surgery. Bull’s eye, short axis (SA) and vertical long axis (VLA) slices of 18F-FDG showed an inferior segmental FDG hypermetabolism with no significant uptake in other myocardial wall. A rest tetrofosmin myocardial scintigraphy showed inferior myocardial hypoperfusion mismatch congruent with the segmental FDG uptake. Coronary angiography demonstrated a very narrow proximal right coronary artery stenosis treated with percutaneous angioplasty.
From what is currently known about the regional myocardial FDG uptake variability [1], one might think that it is difficult to identify an ischaemic cardiopathy on a routine oncology PET scan. Nevertheless, glycolysis is stimulated in the ischaemic myocardium [2, 3], which is consistent with our observation of inferior myocardial increased FDG uptake corresponding to hibernating myocardium in an area distal to a severe right coronary artery stenosis with rest hypoperfusion. In our experience, inferior segmental myocardial FDG uptake is rarely seen in oncology PET scans but should not be ignored.
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Vilain, D., Bochet, J., Le Stanc, E. et al. Unsuspected hibernating myocardium detected by routine oncology 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 37, 409 (2010). https://doi.org/10.1007/s00259-009-1323-6
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DOI: https://doi.org/10.1007/s00259-009-1323-6