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SPECT Versus PET Myocardial Perfusion Imaging in Patients with Equivocal CT

  • Nuclear Cardiology (V Dilsizian, Section Editor)
  • Published:
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Abstract

Purpose of Review

The most pertinent clinical question in post-coronary computed tomography angiography (CCTA) patients is the assessment of the physiological significance of an anatomically identified stenosis. The clinical application of radionuclide MPI using single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) in the evaluation and management of patients with an inconclusive CCTA is reviewed using a case-based approach.

Recent Findings

Recent evidence suggests that CCTA is the most sensitive non-invasive test to exclude angiographic CAD and may be an effective first-line test especially among symptomatic low-intermediate risk patients. However, in the presence of angiographic atherosclerosis, its specificity and positive predictive value for identifying flow-limiting stenosis are modest.

Summary

Radionuclide myocardial perfusion imaging offers accurate quantitative assessment of myocardial ischemia, which helps with risk stratification and patient management especially the potential need for revascularization. Routine accurate quantifications of myocardial blood flow and flow reserve are major advantages of PET MPI, which are especially useful when used in patients at intermediate-high clinical risk.

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Abbreviations

MPI:

Myocardial perfusion imaging

CAD:

Coronary artery disease

SPECT:

Single-photon emission computed tomography

PET:

Positron emission tomography

CCTA:

Coronary computed tomography angiography

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

HTN:

Hypertension

HLD:

Hyperlipidemia

DM:

Diabetes mellitus

ER:

Emergency department

ECG:

Electrocardiogram

hs-TnT:

High-sensitivity troponin T

LCx:

Left circumflex

LAD:

Left anterior descending

RI:

Ramus intermedius

METs:

Metabolic equivalents

APMHR:

Age-predicted maximal heart rate

BP:

Blood pressure

ICA:

Invasive coronary angiogram

LV:

Left ventricular

RV:

Right ventricular

CMD:

Coronary microvascular dysfunction

CTO:

Chronic total occlusion

PCI:

Percutaneous coronary intervention

RCA:

Right coronary artery

CABG:

Coronary artery bypass grafting

CKD:

Chronic kidney disease

LM:

Left main

LIMA:

Left internal mammary artery

SVG:

Saphenous venous graft

RPDA:

Right posterior descending artery

RPLV:

Right posterolateral vessel

Afib:

Atrial fibrillation

ETT:

Exercise treadmill test

CV:

Cardioversion

PHTN:

Pulmonary hypertension

FFR:

Fractional flow reserve

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Authors and Affiliations

  1. Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Vasvi Singh & Marcelo F. Di Carli

  2. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Vasvi Singh & Marcelo F. Di Carli

  3. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Vasvi Singh & Marcelo F. Di Carli

  4. Brigham and Women’s Hospital, 75 Francis St, ASB-L1 037C, Boston, MA, 02115, USA

    Marcelo F. Di Carli

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Correspondence to Marcelo F. Di Carli.

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Vasvi Singh declares that she has no conflict of interest.

Marcelo F. Di Carli has research grants from Spectrum Dynamics and Gilead Sciences, and consulting fees from Bayer and Janssen.

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Singh, V., Di Carli, M.F. SPECT Versus PET Myocardial Perfusion Imaging in Patients with Equivocal CT. Curr Cardiol Rep 22, 43 (2020). https://doi.org/10.1007/s11886-020-01287-0

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