Perfusion cardiovascular magnetic resonance : will it replace SPECT?

In the USA, in 2005, about half of patients who died of a heart attack did not reach the hospital for emergency treatment, indicating the need for earlier detection of coronary artery disease (CAD). Single photon emission computed tomography (SPECT) imaging has a high diagnostic and prognostic power despite some technical limitations. Perfusion- and late-enhancement cardiovascular magnetic resonance (CMR) are not limited by such restrictions. Multicenter trials have found a high diagnostic performance of CMR for the detection of CAD, with one trial additionally showing superiority of CMR over SPECT. The advantages of CMR, eg, lack of radiation exposure, will likely promote a shift toward early CAD detection by CMR. Nevertheless, more efforts are needed to standardize the technique, train physicians and personnel, and improve access to infrastructures.