Myocardial Scintigraphy: Current Status

Nuclear myocardial perfusion imaging using single photon emission computed tomography (SPECT) in combination with various tracers is for many years the most widely used technology for the non-invasive detection of hemodynamically significant coronary artery disease (CAD). Sensitivity and specificity range between 80 and 90% and are comparable to stress echocardiography and stress MR-imaging. Combining SPECT with technetium 99m tracers and using modern technologies such as ECG-triggering and soft tissue attenuation correction algorithms have further sigificantly improved the diagnostic accuracy. Modern cameras in combination with fast data acquisition have reduced the imaging times as well as radiation exposure of the patient. Semi-automated analysis software has improved reproducibility and validity of data analysis. Several large retrospective as well as prospective studies have demonstrated the prognostic value of SPECT perfusion imaging in all stages of CAD. Hybrid imaging using SPECT technology in combination with CT coronary angiography may further improve and fasten the diagnostic work-up of patients with suspected CAD and may reduce the need for overall diagnostic coronary angiography but may also lead to higher proportion of coronary angiography subsequently followed by necessary and indicated coronary revascularization.