Radionuclide Imaging of Cardiovascular Disease

Multiple imaging modalities are clinically available for evaluation of global and regional cardiac function, determination of regional myocardial perfusion, and evaluation of coronary anatomy, including SPECT with CT, PET with CT, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI), and ultrasound. Emblematic of this revolution is the capability of cardiac MDCT to integrate evaluation of coronary artery anatomy with noninvasive assessment of myocardial perfusion and contractile function [1]. MDCT still needs to be technically optimized, particularly to identify small changes in myocardial perfusion, which can be done reproducibly with radionuclide techniques [2]. On the other hand, despite proven clinical efficacy in the detection of CAD (primarily based on the presence of calcium in the coronary arteries), MDCT imaging performs suboptimally in the noninvasive characterization of multivessel CAD. On the other hand, the specificity of nuclear imaging is improved by attenuation correction. Accordingly, multimodality SPECT/CT or PET/CT approach is the current standard for evaluating myocardial perfusion.