Answer

1. The patient underwent resting N-13 NH3 perfusion and F-18 fludeoxyglucose (FDG) metabolic study for myocardial viability assessment
2. The adjacent rows show N-13 NH3 perfusion and F-18 FDG metabolic study, respectively. The rows 1–4 are short axis images; 5 and 6 are vertical long axis; and 7 and 8 are horizontal long axis images [Figure 1].

   Figure 1: (1) What scans she underwent? (2) What are the findings?. Click here to view

Perfusion images show large, hypoperfused area in the anteroseptal wall and apex [white arrows in [Figure 2]. Metabolic images show preserved FDG uptake in the corresponding areas [Figure 2]. This “perfusion and metabolic mismatch” defect in the anteroseptal wall and apex is consistent with hibernating myocardium.^[1]

Figure 2: Perfusion images show large, hypoperfused area in the anteroseptal wall and apex (white arrows). Fludeoxyglucose images show preserved uptake in the corresponding areas. Click here to view

The polar map shows perfusion defect (blacked out area in the N-13 NH3 study) involving the anteroseptal wall and apex, which shows mismatch with FDG images [white area, [Figure 3]]. Software quantification shows 26% left ventricular myocardium is hibernating.^[2] Then, the patient underwent coronary artery bypass surgery as revascularization improves the function of hibernating myocardium.^[1]

Figure 3: The polar map showing perfusion defect (blacked out area in the N-13 NH3 study) involving the anteroseptal wall and apex, which shows mismatch with fludeoxyglucose images (white area). Click here to view

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