Figure 6
Example of false positive SPECT study with a fixed apical defect. (A) Steady state free precession imaging demonstrates a normal right coronary origin (solid arrow) but reveals a retro-aortic course of the left main coronary artery (dotted arrows). (B) The anomalous left main regains the normal position and bifurcates in to LAD (dashed arrow) and Cx (dotted arrow). (C-D) Conventional coronary angiography confirms undistorted coronary origins (solid arrows) and substantiates the presence of an anomalous left main coronary artery (dotted arrows). (E) Bullseye plot from resting SPECT indicates a fixed apical defect suggestive of infarction. (F) Stress perfusion CMR is normal. (G, H) Late gadolinium enhancement images in 2 and 4 chamber orientations show no evidence of any apical infarction.