(A) Myocardial perfusion SPECT images demonstrate a medium-sized defect of marked severity in the anterior apex at stress that improves mildly at rest (arrows). Mild aneurysmal dilatation of the apex is also seen. (B) Stress and resting polar maps again demonstrate the severe, slightly reversible defects (arrows).

Differential Diagnosis

All three diagnoses can demonstrate defects on the rest and stress scans. However, attenuation artifacts should not have regional wall motion abnormalities, and hibernating myocardium requires additional imaging to document.

•  Left anterior descending territory myocardial infarction with mild peri-infarct ischemia: This is the most likely diagnosis to account for a resting defect that worsens on stress and has a regional wall motion abnormality.

•  Hibernating myocardium: