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Quantitation of Myocardial Perfusion: Absolute Blood Flow Versus Relative Uptake

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Atlas of Nuclear Cardiology

Abstract

Myocardial perfusion imaging with single-photon emission CT (SPECT) and positron emission tomography (PET) has emerged as the primary diagnostic modality for the identification and therapy decision-making process of coronary artery disease (CAD). By assessing the relative myocardial distribution of the myocardial blood flow (MBF) during treadmill exercise or pharmacologic stress—for example, with dobutamine stimulation or pharmacologic vasodilation—and during rest, the presence of flow-limiting epicardial coronary artery lesions can be determined. Stress-induced relative reductions in regional MBF, as denoted by diminished regional radiotracer uptake during stress, identify myocardial regions that are subtended by advanced epicardial coronary artery lesions. In contrast, myocardial regions with the highest radiotracer uptake are commonly considered to be supplied by normal or minimally diseased epicardial coronary vessels. Homogenously distributed left ventricular radiotracer uptake during both stress and rest commonly denotes the absence of flow-limiting epicardial coronary artery lesions.

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Acknowledgments

The authors would like to thank Mary Smith for her assistance in preparing this manuscript. This work was supported in part by the Director of the Office of Energy Research, Office of Health and Environmental Research, Washington DC, and in part by Research Grant #HL 33177, National Institutes of Health, Bethesda, MD. Dr. Schindler is supported by grants from the Swiss National Science Foundation (SNF grant: 3200B0-122237), the Clinical Research Center (CRC), University Hospital and Faculty of Medicine, Geneva, Switzerland, the Louis-Jeantet Foundation, Geneva, Switzerland, and the Swiss Heart Foundation.

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  1. Division of Cardiology, Department of Specialties in Medicine, University Hospitals of Geneva, Geneva, Switzerland

    Thomas H. Schindler M.D.

  2. Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Heinrich R. Schelbert M.D., Ph.D.

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  1. Thomas H. Schindler M.D.
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  2. Heinrich R. Schelbert M.D., Ph.D.
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  1. School of Medicine, Dept. Diagnostic Radiology, University Maryland, S. Greene Street 22, Baltimore, 21201, Maryland, USA

    Vasken Dilsizian

  2. , Department of Cardiology, Mount Sinai School of Medicine and Medic, Gustave L. Levy Place 1, New York, 10029, New York, USA

    Jagat Narula

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Schindler, T.H., Schelbert, H.R. (2013). Quantitation of Myocardial Perfusion: Absolute Blood Flow Versus Relative Uptake. In: Dilsizian, V., Narula, J. (eds) Atlas of Nuclear Cardiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5551-6_5

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