Hybrid anatomo-functional imaging of coronary artery disease: Beneficial irrespective of its core components

Abstract

Coronary artery disease (CAD) is the most common and important cause of ischemic heart disease, with major implications on global morbidity and mortality. Non-invasive testing is crucial in the diagnostic and prognostic work-up of patients with or at risk of CAD, and also to guide decision making in terms of pharmacologic and revascularization therapy. The traditional paradigm is to view anatomic (i.e., coronary computed tomography) and functional imaging (e.g., myocardial perfusion scintigraphy) tests as opposing alternatives. Such approach is too reductionist and does not capitalize on the strengths of each type of test while risking to overlook the inherent limitations. The combination of anatomic and functional tests in a logic of hybrid imaging holds the promise of overcoming the limitations inherent to anatomic and functional testing, enabling more accurate diagnosis, prognosis, and guidance for revascularization in patients with CAD.

Diagnostic Effect of Attenuation Correction in Myocardial Perfusion Imaging in Different Coronary Arteries: A Systematic Review and Meta-Analysis

“…With the development of newer cameras, the CT in SPECT/CT can also perform anatomic imaging of coronary arteries. Combining anatomic and functional hybrid imaging can overcome the limitations inherent to anatomic and functional testing alone, and allow for a more accurate diagnosis and guidance for interventions in patients with CAD ( 11 , 44 ).…”

Hybrid imaging and publishing

“…The paper by Nudi et al in this issue makes a great argument for its use in CAD. 9 Schwaiger et al argued ''the technology ''Hybrid PET and MR'' holds great promise for providing unique information especially in the area of plaque imaging as well as in molecular characterization of inflammatory processes. Future research will tell if these applications will have the necessary clinical impact on management of patients with cardiovascular diseases''.…”

Promises and pitfalls of relying on angiography-derived indexes to identify myocardial ischemia: A tale of Romulus and Remus

“…7 Indeed, considering a functional test as a valid comparator of an anatomic one, or vice versa, misses the whole point of patient-centered integration of multimodality imaging. 8 This logical step is, however, challenging for many, including ourselves. Yet we need to recognize that, for instance, using invasive coronary angiography as a diagnostic benchmark for myocardial perfusion imaging (MPI) was a crude comparative approach, in as much as it is using MPI to validate noninvasive angiography-derived indexes.…”