Nuclear Cardiology Board Review Sample Questions

The correct answer is A. There is normal myocardial perfusion and no evidence of myocardial ischemia but an abnormality is noted on "rotating" planar imaging.

Explanation: There is normal myocardial perfusion and no evidence of myocardial ischemia but an abnormality is noted on "rotating" planar imaging. Explanation: Stress and rest tomographic images demonstrate homogeneous and physiologic tracer distribution throughout the entire left ventricular myocardium.

No reversible perfusion defects are seen in the anterior or septal regions. In the rotating planar image, there are two foci of tracer uptake in the expected region of the gallbladder. Tc99m Sestamibi is normally excreted in the hepatobiliary system and can be considered a "poor" man's HIDA scan. Normally tracer is visualized in the liver, gallbladder, and bowel. In this case, two foci of increased tracer uptake in the region of the gallbladder raise suspicious for an abnormality, possibly a choledochal cyst or abnormality in the gallbladder itself.

The patient proceeded to have a HIDA scan due to abdominal pain and the images demonstrated similar findings as pictured below. The focus of tracer uptake at the medial aspect of the gallbladder was felt to possibly represent a choledochal cyst or part of the gallbladder and MRCP was recommended for further evaluation and is pictured below (both coronal and axial images). MRCP demonstrated a band-like soft tissue density seen at the waist of the gallbladder consistent with an hourglass type of adenomyomatosis. This case confirms that it is always important to review the rotating planar images for extracardiac findings.