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Atypical exercise stress myocardial perfusion SPECT imaging in a patient with effort angina pectoris.

xercise or pharmacological stress myocardial perfusion single-photon emission computed tomography (SPECT) has been used in daily clinical practice as a reliable diagnostic modality and a prognostic marker for patients with coronary artery disease.1–3 We herein report atypical exercise stress myocardial perfusion SPECT imaging in a patient with effort angina pectoris. A 58-year-old male who had felt anterior chest pain during walking was referred to our hospital. He was suspected of having effort angina pectoris, and he underwent exercise stress/rest myocardial perfusion SPECT with a dual-isotope protocol using 201Tl at rest and 99mTc-tetrofosmin for stress imaging. Stress SPECT imaging showed a reduced tracer accumulation only in the basal anterior segment, including the anterolateral and a part of the anteroseptal segments (Figure 1A, black triangles). Rest imaging did not show reduced tracer accumulation in any segments, thus suggesting myocardial ischemia in the basal anterior wall. Coronary angiography was then carried out. The right coronary angiograms did not show any significant stenosis (Figure 2A). The