Anteroapical Fixed Defect: LAD Infarction on MPI
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Question
An anteroapical fixed perfusion defect (present at both stress and rest) on MPI, combined with gated SPECT showing regional wall motion abnormality and reduced LVEF, is most consistent with:
- ABreast attenuation artifact
- BAnterior wall myocardial infarction in the LAD territory
- CIschemia in the LCX territory
- DDilated cardiomyopathy
Show the answer and explanation
B. Anterior wall myocardial infarction in the LAD territory
Anterior and apical myocardial walls are supplied by the left anterior descending artery (LAD). A fixed (non-reversible) perfusion defect in these territories on SPECT, combined with wall motion abnormality and reduced LVEF on gated SPECT, is classic for prior LAD territory myocardial infarction with resultant scar and regional dysfunction. Artifacts like breast attenuation don't cause wall motion abnormalities. Gated SPECT is essential for differentiating true fixed defects from attenuation artifacts — wall motion is normal in artifacts.
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