Severe myocardial ischemia detected in routine oncological positron emission tomography/computed tomography with 18F-fluorodeoxyglucose.

A 69-year-old man underwent positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (18F-FDG-PET/CT) for staging of recurrent seminoma. He had no prior known cardiac disease but stable angina pectoris. The patient fastened as per protocol for 6 h with blood glucose 5.3 mmol/L prior to injection of 18F-FDG. A strong 18F-FDG-uptake was observed only in the apex of the heart, whereas the rest of the myocardium showed incidental suppressed myocardial FDG-uptake. Without specific preparation, this condition is less common in routine 18F-FDG-PET/CT and also termed ‘lipid-shift’ of cardiac metabolism (Panel A). The CT images showed calcified coronary arteries. He was referred for a 82rubidium-PET/CT scan, which revealed severe ischemia in the territory of the left anterior descending artery (LAD) matching the region of the 18F-FDG-uptake (Panel B). Coronary angiography confirmed occlusion of the apical LAD (Panel C) with retrograde perfusion by right coronary artery, and the patient successfully underwent non-invasive coronary revascularization.