Example of discordant findings between SPECT and CMR. A 77-year-old patient with three vessel coronary artery disease and inferior and lateral akinesia with severe LV dysfunction (EF 36%) underwent both resting MIBI SPECT and LGE-CMR for assessment of myocardial viability. Resting MIBI SPECT shows severe hypoperfusion in septal, inferior and infero-lateral segments, suggesting absence of viable myocardium. LGE-CMR by contrast shows only small areas of subendocardial scar with <25% transmural extent, indicating relatively large amounts of dysfunctional myocardium with preserved viability. CMR, cardiovascular magnetic resonance; LGE, late-gadolinium enhancement; LV, left ventricular; SPECT, single photon emission computed tomography.