Difference in filtered-back projection and iterative reconstruction in a patient with increased splanchnic uptake

We performed a dual isotope, gated adenosine stress myocardial perfusion study on a 44-year-old man. Using filtered-back projection, images showed an inferior wall defect. However, intense liver uptake during adenosine stress was suspected to inaccurately cause diminished inferior wall counts. The patient has end-stage renal disease, diabetes mellitus, and hypertension. The excessive hepatic uptake was noted on planar rotating images and is likely related (at least in part) to reduced renal uptake (not shown subsequently). Using iterative reconstruction, the inferior cardiac defect was markedly reduced. The patient subsequently underwent surgery without complication.