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SPECT Myocardial Perfusion Imaging — EECC MCQ

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EasyCardiac ImagingSPECT Myocardial Perfusion ImagingEECC

A 65-year-old woman with known stable CAD and suspected ischaemia undergoes SPECT myocardial perfusion imaging with technetium-99m sestamibi. Stress images show a fixed perfusion defect in the inferior wall with no reversibility at rest. What does this finding indicate?

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Correct answer: C — Myocardial scar (infarction) in the inferior territory without significant residual ischaemia

On SPECT myocardial perfusion imaging, a fixed perfusion defect (present on both stress and rest images with no reversibility) indicates myocardial scar from prior infarction. A reversible defect (present on stress but resolving at rest) indicates inducible ischaemia. While diaphragmatic attenuation can cause fixed inferior defects as an artefact, clinical context (known CAD) makes true scar more likely; attenuation correction and prone imaging can differentiate these. Hibernating myocardium (viable but dysfunctional tissue that improves with revascularisation) requires additional viability assessment (CMR with LGE, PET with FDG, or dobutamine echo) and is not definitively diagnosed by SPECT alone.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes