LAUSR

The patient was a 49-year-old man who had history of malignant melanoma and angina. Follow-up FDGPET/CT [12 hours after overnight fasting showed no findings of recurrence, except focal uptake in the left ventricular (LV) inferior wall (Figure 1A). Adenosine stress N-ammonia PET revealed abnormal coronary flow reserve (CFR) (\2.0) in all territories and \1 in the inferior wall, suggesting multivessel disease (Figure 1B). The coronary angiogram showed severe stenosis in the left anterior descending artery, intermediate stenosis in the left circumflex artery (Figure 2A), and chronic occlusion in the right coronary artery (RCA) (Figure 2B). The abnormal wall motion in the inferior LV wall on the echocardiogram was restored after coronary artery bypass grafting (CABG), which was consistent with hibernating myocardium. Focal FDG uptake in the LV inferior wall markedly diminished after CABG (Figure 3A). Re-examination of N-ammonia PET scans showed the CFR to be improved in all territories ([2.0) (Figure 3B).