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An institutional review board–approved retrospective review of 55 patients who received cardiac MRI within 1 year of myocardial SPECT was performed. Forty-nine demonstrated myocardial infarction by MRI. MRI and SPECT agreed in all but 1 case, where SPECT preceded MRI by 97 days. Three cases are presented here: 2 demonstrating congruent MRI and SPECT changes in a vascular distribution status post infarction and a third with a nonvascular pattern of abnormalities related to left ventricular aneurysm in cardiac sarcoidosis. It is useful to review and correlate myocardial SPECT with available cardiac MRI, especially in patients with matching perfusion defects.