Integration of coronary anatomy and myocardial perfusion imaging

Abstract

Advances in cardiovascular imaging have resulted in the development of multiple noninvasive techniques to evaluate myocardial perfusion and coronary anatomy, each of which has unique strengths and limitations. For example, CT angiography can directly visualize the presence of atherosclerosis, but the hemodynamic effect of many lesions identified by this technique is unknown. Alternatively, myocardial perfusion imaging enables a physiological assessment, but it may underestimate the extent of atherosclerosis in patients with multivessel disease. Dual-modality simultaneous imaging or multimodal sequential imaging techniques facilitate integration of information on both myocardial perfusion and coronary anatomy, and thus have the potential to improve diagnostic and prognostic evaluation, which could translate into improved care of patients. This Review discusses the strengths and limitations of the currently available individual noninvasive techniques for imaging coronary anatomy and myocardial perfusion. Approaches to integration of these imaging modalities are described, followed by an exploration of the clinical utility and future directions of hybrid imaging.

Can Advances in Nuclear Cardiology Hardware Overcome the Challenges of Imaging Obese Patients?

“…15 Thus, this study supports the use of SPECT MPI using a CZT detector with a dedicated parallel-hole collimation system as a first-line testing option for obese patients who have an appropriate indication for MPI. Since PET MPI 16 and cardiac MRI 2 have also been shown to provide adequate image quality and prognostically important findings in obese patients, future research should compare the diagnostic accuracy of the parallelhole collimator CZT SPECT camera against these modalities.…”

Low Yield of Routine Preoperative Coronary Computed Tomography Angiography in Patients Evaluated for Liver Transplantation

“…It has a very high sensitivity (≈90%) and negative predictive value (≈96%) for excluding significant CAD. 13 Given its high negative predictive value, a normal scan result (expected in approximately two thirds of patients with end-stage liver disease on the basis of the present report) effectively excludes obstructive CAD and abolishes the need for further investigation. Stress myocardial perfusion scintigraphy and echocardiography have been used in these patients with mixed results, 1 likely related to the variable sensitivity of these approaches.…”

Nuclear cardiology

“…Both SPECT and PET cameras have been combined with computed X-ray tomography (CT), offering not only more accurate attenuation correction but also making possible evaluation of coronary calcification and coronary anatomy in the same sitting with myocardial perfusion. 2 …”