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Improved Performance of PET Myocardial Perfusion Imaging Compared to SPECT in the Evaluation of Suspected CAD

  • Cardiac PET, CT, and MRI (P Cremer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) has played a central role in the non-invasive evaluation of patients with obstructive coronary artery disease (CAD) for decades. In this review, we discuss the key differences and advantages of positron emission tomography (PET) MPI over SPECT MPI as it relates to the diagnosis, prognosis, as well as clinical decision-making in patients with suspected CAD.

Recent Findings

Stress-induced perfusion abnormalities on SPECT help estimate presence, extent, and location of ischemia and flow-limiting obstructive CAD, help with risk stratification, and serve as a gatekeeper to identify patients who will benefit from downstream revascularization versus medical management. Some of the major limitations of SPECT include soft-tissue attenuation artifacts, underestimation of ischemia due to reliance on relative perfusion assessment, and longer protocols with higher radiation dose when performed with traditional equipment. PET MPI addresses most of these limitations and offers better quality images, higher diagnostic accuracy along with shorter protocols and lower radiation dose to the patient. A special advantage of PET scanning lies in the ability to quantify absolute myocardial blood flow and assess true extent of epicardial involvement along with identifying non-obstructive phenotypes of CAD such as diffuse atherosclerosis and microvascular dysfunction. In addition, stress acquisition at/near peak stress with PET allows us to measure left ventricular ejection fraction reserve and myocardial blood flow reserve, which help with identifying patients at a higher risk of future cardiac events and optimally select candidates for revascularization.

Summary

The several technical advantages of PET MPI position as a superior method to diagnose obstructive and non-obstructive phenotypes of ischemic heart disease affecting the entirety of the coronary circulation offer incremental value for risk stratification and guide post-test management strategy for patients with suspected CAD.

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Fig. 1

(Reproduced from Patel et al. ACC Cardiovasc Imaging. 2022;15(6):1158–9, with permission from Elsevier) [23]

Fig. 2

(Reproduced from Patel et al. ACC Cardiovasc Imaging. 2022;15(9):1635–44, with permission from Elsevier) [5•]

Fig. 3
Fig. 4

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Authors and Affiliations

  1. Department of Cardiology, Mount Sinai Morningside, New York, NY, USA

    Loba Alam, Alaa Mabrouk Salem Omar & Krishna K. Patel

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Loba Alam & Alaa Mabrouk Salem Omar

  3. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Krishna K. Patel

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  2. Alaa Mabrouk Salem Omar
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  3. Krishna K. Patel
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Correspondence to Krishna K. Patel.

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Krishna K. Patel reports an institutional research grant from Jubliant DraxImage, Inc. The other authors declare no competing interests.

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Alam, L., Omar, A.M.S. & Patel, K.K. Improved Performance of PET Myocardial Perfusion Imaging Compared to SPECT in the Evaluation of Suspected CAD. Curr Cardiol Rep 25, 281–293 (2023). https://doi.org/10.1007/s11886-023-01851-4

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