We present the case of a 62-year-old man with colorectal carcinoma with unusual segmental myocardial 18F-FDG uptake. PET/CT scan was requested for evaluating response to chemotherapy before surgery. Bull’s eye, short axis (SA) and vertical long axis (VLA) slices of 18F-FDG showed an inferior segmental FDG hypermetabolism with no significant uptake in other myocardial wall. A rest tetrofosmin myocardial scintigraphy showed inferior myocardial hypoperfusion mismatch congruent with the segmental FDG uptake. Coronary angiography demonstrated a very narrow proximal right coronary artery stenosis treated with percutaneous angioplasty.

From what is currently known about the regional myocardial FDG uptake variability [1], one might think that it is difficult to identify an ischaemic cardiopathy on a routine oncology PET scan. Nevertheless, glycolysis is stimulated in the ischaemic myocardium [2, 3], which is consistent with our observation of inferior myocardial increased FDG uptake corresponding to hibernating myocardium in an area distal to a severe right coronary artery stenosis with rest hypoperfusion. In our experience, inferior segmental myocardial FDG uptake is rarely seen in oncology PET scans but should not be ignored.