FIGURE 5.  Simultaneous myocardial perfusion and metabolism imaging after dual intravenous injection of ^99mTc-sestamibi and ¹⁸F-FDG at peak exercise. Dual-isotope simultaneous acquisition was performed 40–60 min after exercise study was completed. Rest ^99mTc-sestamibi imaging was performed separately. In this patient with angina and no prior myocardial infarction, there is evidence of extensive reversible perfusion defect in anterior, septal, and apical regions (arrows). Coronary angiogram showed 90% stenosis of left anterior descending and 60% of left circumflex coronary arteries. The corresponding ¹⁸F-FDG image shows intense uptake in regions with reversible sestamibi defects (arrows), reflecting the metabolic correlate of exercise-induced myocardial ischemia. Ex = exercise; R = rest. (Adapted from (45).)