NC Today: Challenges and Controversies: Case-based Discussion


View the Nuclear Cardiology Today controversial cases to be discussed and join us in Boston, MA, April 28-29, 2023.

The program will include 4 intensive, interactive case-based learning modules. Each starts and ends with a case discussion and will feature 2-3 practical dilemmas to encourage peer-to-peer discussion of best approaches to solve everyday clinical issues.

The sessions will include Cardiac Amyloidosis, SPECT, PET, and PatientFirst Imaging with a focus on the controversies and decision points that experts will debate live at NC Today. Register now to reserve your front-row seat and join in the discussion!


Challenges and Controversies: Case-based Discussion

  1. How do you report a study if the perfusion images are normal but global myocardial blood flow reserve is severely abnormal?  What do you do next?
  2. The MBFR is reduced because resting MBF is high.  Should resting MBF be corrected for RPP, and if so should the “real” MBFR or the corrected MBFR be reported?
  3. Can a diagnosis of coronary microvascular disease be made on the basis of MBFR alone, or is anatomic assessment required?
  4. If you suspect inadequate suppression of physiologic myocardial FDG uptake, do you repeat the test with extended patient prep?
  5. How to interpret a PET perfusion defect if regional flow in that territory is convincingly normal?
  6. Do you ever repeat a PET scan because the MBF data is technically unusable?
  7. When do we use FDG PET or WBC scan in endocarditis?
  8. Should we use heparin as part of the sarcoid prep?

Challenges and Controversies in Cardiac Amyloidosis: Cases with ACEs

  1. I am gene positive for TTR, my Tc-99m PYP and Echos are normal. When, if at all, should the Tc-99m PYP study be done?
  2. 70-yr-old male presents with signs and symptoms of ATTR amyloid.  Tc-99m PYP scan is grade 1. Do you proceed to CMR or end-myocardial biopsy or initiate treatment for TTR amyloidosis?
  3. Is there any reason to report H/CL ratio if SPECT is done?
  4. Should we get a gene test in everyone with suspected ATTR amyloid? (Can we say that a pt does not have cardiac amyloidosis based just on normal PYP and serum/urine studies if the echo is suspicious?)
  5. Revisiting 1 hr vs 3 hr PYP in the current era of mandatory SPECT. Do we lose sensitivity with delayed imaging? Especially with HMDP?
  6. Are there other findings on SPECT- CT beyond LV uptake that are helpful in diagnosis amyloid (atrial uptake, RV uptake)?
  7. Can I do serial PYP scans to determine if tafamidis therapy for ATTR-CM is effective? Most patients who undergo Tc-99m PYP scans have many incidental findings (especially of using SPECT/CT), how much to report? What is the best wording? When readers say “recommend formal diagnostic CT,” provider is obligated to follow up. Implications?