A patient with peripheral arterial stenosis diagnosed with lower extremity perfusion scintigraphy

A 42-year-old man attending cardiology outpatient clinic for single-vessel coronary artery disease was on medical treatment. An exercise myocardial perfusion-SPECT was performed to monitor his response. The exercise test was terminated when claudication occurred in his right leg during the second stage. Planar scintigraphic images of both crural regions were obtained following Tc-99m sestamibi injection. Images were obtained 15 minutes after a single injection of 10 mCi. A remarkable decrease in perfusion was observed in the right crural region, when compared with the left. Doppler examination of the right lower extremity revealed normal arterial circulation. Peripheral arterial angiography was ordered, and revealed multiple stenoses of the right common iliac and right external iliac arteries. In cases where arterial examination may be misleading due to well-developed collateral circulation, or where Doppler examination of intraabdominal vasculature poses anatomic difficulties, perfusion scintigraphy of lower extremities may be helpful before considering more invasive procedures, such as angiography.(1-10)