NucMed Boards Prep
IMAGE INTERPRETATION · CARDIAC IMAGING

Fixed Perfusion Defect: Myocardial Scar on SPECT

Myocardial perfusion SPECT — short axis slices, stress and rest
Myocardial perfusion SPECT — short axis slices, stress and rest

CC BY-SA 3.0 · Wikimedia Commons · source file

Question

This myocardial perfusion SPECT shows a perfusion defect in the anterior and apical walls that is present on BOTH stress and rest images (no fill-in on rest). This type of defect is called a fixed defect. What does a fixed (non-reversible) defect represent?

  1. AReversible ischemia — viable myocardium that requires revascularization
  2. BDiaphragmatic attenuation artifact
  3. CBalanced ischemia in the LAD territory
  4. DMyocardial scar (infarction) — non-viable myocardium
Show the answer and explanation

D. Myocardial scar (infarction) — non-viable myocardium

A fixed (non-reversible) perfusion defect — present on both stress and rest images without fill-in — represents myocardial scar/infarction (non-viable, replaced by fibrous tissue). The anteroapical wall is supplied by the LAD, so this pattern indicates prior LAD territory infarction. A reversible defect (present at stress, absent at rest) indicates ischemia with viable myocardium. The distinction guides clinical management: ischemia may benefit from revascularization, while scar does not.

More cardiac imaging images

Myocardial perfusion SPECT — lateral wall defect present at stress, resolved at restReversible Lateral Wall Defect: Circumflex Ischemia Myocardial perfusion SPECT — polar map (bull's-eye plot)Bull’s-Eye Polar Map: What the Center Shows Myocardial perfusion SPECT — anteroapical fixed perfusion defectAnteroapical Fixed Defect: LAD Infarction on MPI Myocardial perfusion SPECT — lateral wall stress/rest defect comparisonTransient Ischemic Dilation (TID) on Gated SPECT Myocardial perfusion imaging — stress and rest SPECT imagesRb-82 PET Perfusion and the Sr-82/Rb-82 Generator Myocardial perfusion scan — potential attenuation artifact in female patientBreast Attenuation Artifact on Myocardial Perfusion SPECT
← Diaphragmatic Attenuation Artifact on Cardiac SPECTReversible Lateral Wall Defect: Circumflex Ischemia →

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