Photon deprivation artifact on nuclear cardiac stress test due to infiltration of technetium

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Elderly male admitted for acute coronary symptoms. Adenosine stress test performed. Stress images first followed by rest images shown with prone stress images.

Patient Data

Age: 70 years
Gender: Male

Infiltration of Technetium into subcutaneous tissue-4 DM software post processing here.

Nuclear medicine

Stress images are readable as there is no inflitration and is performed first in our institution.

EF is calculable by gated technique.

Polar maps and visual assessment shows no ischemia or infarct of significance.

QA raw data is very useful to identify there was subcutaneous infiltration as there was radionuclide uptake in right axillary lymph node and not be confused as cancerous uptake.

Mask failure recognized by Cedar Sinai Software automatically.

Nuclear medicine

There are many post processing software's.

Cedar Sinai software recognized automatically and mentions there is a masking error for the radiologist reviewing the study to critic the QA.

Case Discussion

Since stress injection images performed first there is radio nuclide decay seen over the heart on rest imaging here.

If rest images done first and there was infiltration of radio nuclide, there would have been no cardiac uptake and even more photon deprivation artifact.

Since stress test results were showing no ischemia or infarct. We did not repeat the rest imaging.

We were able to review the stress gated imaging adequately.

Another thing to keep in mind when there is an inpatient with multiple IV lines the technologist must be aware of the mechanisms of using T shaped valves and turning in the correct direction while injecting and using the flush adequately. Not to inject into long IV lines and inject as close to vein as possible to avoid injection related fallacies and artifacts.

 

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