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Nuclear cardiology: myocardial perfusion imaging with SPECT and PET

¹ Radionuclide Radiology Department, Nottingham University Hospital, Queen's Campus, Derby Road, Nottingham NG7 2UH, ² Radionuclide Radiology Department, Nottingham University Hospital, City Campus, Hucknall Road, Nottingham NG5 1PB, ³ Institute of Nuclear Medicine, University College London Hospital, 235, 5th Floor, Euston Road, London NW1 2BU, UK

• The principal cardiac nuclear imaging technique in current use is myocardial perfusion scintigraphy (MPS), with PET and PET/CT emerging as important new modalities.
  
• All three techniques are accurate and cost-effective in the diagnosis and prognosis of coronary artery disease, providing data on both perfusion and myocardial viability.
  
• MPS is significantly underutilised in the UK relative to Europe and the USA, and NICE guidance recommends its wider use.
  
• PET offers improved efficiency, resolution and quantitative imaging capacity, but its use is so far limited owing to the small number of scanners available.
  
• Fusion PET/CT adds non-invasive coronary angiography and calcium scoring to provide the most complete picture of coronary function available to date.
  

Nuclear cardiology has seen many significant advances since its inception 30 years ago, and has risen to the challenge of providing cost effective and accurate diagnostic, prognostic and risk stratification data pertaining to the biggest single cause of morbidity and mortality in the Western world, coronary artery disease (CAD). Currently available techniques allow accurate screening for CAD, measurement of perfusion flow rates and flow reserve, and assessment of myocardial viability prior to surgical revascularization. The emerging modality of cardiac positron emission tomography (PET) offers the prospect of improved resolution, accurate quantification of blood flow (especially important for the better detection of global balanced ischaemia) and shorter examination times than the currently most commonly employed technique, myocardial perfusion scintigraphy (MPS). The novel technique of fusion positron emission tomography/computed tomography (PET/CT) in the cardiac setting combines the high quality perfusion images of PET with superb anatomical images of the coronary arteries. This review article will discuss MPS using single photon emission computed tomography (SPECT) as well as cardiac applications of PET and PET/CT. Particular attention will be given to the clinical relevance of the information provided by these imaging techniques.