Diagnostic evaluation of chest pain using myocardial perfusion imaging (MPI) is a common method employed to look for
coronary artery disease (CAD). The isotopes used in MPI are also useful for imaging cancer, including breast cancer. We present a
case where breast cancer was diagnosed using a quantitative method which simultaneously looks for cancer and CAD.
Diagnostic evaluation of patients with chest pain may include
myocardial perfusion imaging. During the initial stress imaging
evaluation, differences in regional blood flow and metabolism
differentiates normal coronary blood flow from abnormal – viz.
ischemia. Breast cancers are also associated with increased
regional blood flow and metabolism and can be seen during the
initial imaging as was done in this woman. Awareness of these
similarities resulted in identification and successful treatment of
her breast cancer prior to further spread of the cancer.
A 39-year old woman presented with atypical chest pain.
She was referred for myocardial perfusion imaging. Following
pharmacologic stress, her initial images - shown here - were
acquired 5-minutes after isotope injection. A mass was identified
in her right breast and was surgically removed revealing a Stage IIA
breast cancer without LN involvement. Additional workup revealed
no evidence of metastatic disease. The patient elected to undergo
no further treatment.
Quantitative measurement following enhancement of regional
blood flow differences, which reflect both changes in metabolism
and regional blood flow, can be measured to unmask ischemia and
cancers . These changes can reflect CAD, which is itself caused by
inflammation , as well as pre-cancerous changes, which can also
be associated with inflammation.
By understanding the fundamental differences in tissue
resulting from changes in metabolism and regional blood flow
differences, nuclear imaging can quantitatively unmask CAD and
hidden cancer (Figure 1).