Radionuclide Myocardial Perfusion Imaging for the Evaluation of Patients With Known or Suspected Coronary Artery Disease in the Era of Multimodality Cardiovascular Imaging

doi:10.1016/j.pcad.2015.03.004

Progress in Cardiovascular Diseases

Volume 57, Issue 6, May–June 2015, Pages 644-653

https://doi.org/10.1016/j.pcad.2015.03.004 Get rights and content

Abstract

Over the last several decades, radionuclide myocardial perfusion imaging (MPI) with single photon emission tomography and positron emission tomography has been a mainstay for the evaluation of patients with known or suspected coronary artery disease (CAD). More recently, technical advances in separate and complementary imaging modalities including coronary computed tomography angiography, computed tomography perfusion, cardiac magnetic resonance imaging, and contrast stress echocardiography have expanded the toolbox of diagnostic testing for cardiac patients. While the growth of available technologies has heralded an exciting era of multimodality cardiovascular imaging, coordinated and dispassionate utilization of these techniques is needed to implement the right test for the right patient at the right time, a promise of “precision medicine.” In this article, we review the maturing role of MPI in the current era of multimodality cardiovascular imaging, particularly in the context of recent advances in myocardial blood flow quantitation, and as applied to the evaluation of patients with known or suspected CAD.

Section snippets

Multimodality appropriate use

At its peak nearly a decade ago, an estimated 40 million noninvasive cardiac examinations were being performed annually in the United States, with cardiac imaging accounting for a considerable proportion of the Medicare budget.3., 4. Recognizing the relative explosion of new cardiac imaging technologies and its impact on the practicing clinician, the American College of Cardiology along with other professional societies recently published the first Multimodality Appropriate Use Criteria, in

Strengths and limitations of radionuclide MPI

Radionuclide MPI effectively began in the early 1970s with the first reports of noninvasive evaluation of MBF at rest, and subsequently, with the addition of ²⁰¹Tl MPI to electrocardiogram (ECG) exercise treadmill (ETT) testing.⁶ Since then, significant technological advances in hardware, software, and radiopharmaceuticals have transformed the field of nuclear cardiology (Fig 1). Currently, imaging techniques such as SPECT and PET allow for the assessment of flow-limiting CAD by evaluation of

Tailoring the imaging test to the clinical question

From the discussion above, it is clear that no single imaging modality can provide all the answers in every patient. While some have advocated for the search of the imaging modality that can be used as the “one-stop shop”, we prefer to think of the ideal modern CV imager as an expert with a bigger toolbox that provides complementary rather than competitive information. In some cases, as in patients on the very extreme spectrum of clinical risk, no imaging may be needed. As with anything in

Conclusion

We are fully in an era of multimodality imaging in the CV realm. At their core, the multiple imaging techniques at our disposal share in common the need to be utilized judiciously in the context of patient-centered clinical care coupled with interdisciplinary clinical judgment, and to be constantly evaluated for their contributions to clinical outcomes.

Disclosures

None.

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Standardized definitions from the 2001 and 2013 American Heart Association exercise standards for testing and training were used to define EST variables and to determine normal and abnormal responses to exercise.10,11 Myocardial perfusion imaging was considered positive if there was any perfusion defect, abnormal viability, transient ischemic dilation, or evidence of global or regional left ventricular systolic dysfunction at rest or after stress.12 Results were categorized as positive, negative, or missing.
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Radionuclide Myocardial Perfusion Imaging for the Evaluation of Patients With Known or Suspected Coronary Artery Disease in the Era of Multimodality Cardiovascular Imaging

Abstract

Section snippets

Multimodality appropriate use

Strengths and limitations of radionuclide MPI

Tailoring the imaging test to the clinical question

Conclusion

Disclosures

J Am Coll Cardiol Img

J Am Coll Cardiol

Semin Nucl Med

Am J Med

J Am Coll Cardiol

Semin Nucl Med

J Am Coll Cardiol

J Nucl Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Nucl Cardiol

JACC Cardiovasc Imaging

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Nucl Cardiol

J Am Coll Cardiol

J Nucl Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease

Circulation

A new initiative on precision medicine

N Engl J Med