Clinical Presentation
A 48-year-old woman presents with shortness of breath and chest discomfort. The top two rows are standard stress and rest imaging obtained with Tc99m MIBI and thallium 201, respectively; the bottom row of each axis is 24-hour-delay imaging of the Tl201 energy window.
(A) Standard initial stress and rest myocardial perfusion scintigraphy (top two rows) demonstrates a predominantly fixed (only slightly reversible) inferolateral perfusion defect (arrows). However, there is normalization of tracer on the delayed redistribution images (circle, third row). (B) These findings are confirmed on the polar maps (arrow).
Differential Diagnosis
• Hibernating myocardium: A defect at rest that resolves/redistributes on delayed thallium imaging indicates hibernating myocardium.
• Myocardial infarction: This will also have a resting perfusion defect but will not redistribute on delayed imaging.
• Stress-induced reversible ischemia:
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