Should early post-stress imaging be performed on a routine clinical basis for myocardial perfusion studies?

Excerpt

Establishing imaging protocols for radionuclide myocardial perfusion imaging (as with any other radiotracers used in nuclear medicine) always requires some sort of trade-off in order to obtain an “optimal” imaging protocol.1 Various considerations must be taken into account before finalizing recommendations for imaging with a specific agent. Even after general consensus in the medical literature, new clinical data or new type of equipment or softwares could and should modify the “standard” imaging protocol guidelines.2 Among those parameters, considerations must be applied to the “practicality” of the imaging protocol in a day-to-day clinical setting in order to answer the clinical question in a reasonable time-frame. Before obtaining the optimal protocol for a myocardial perfusion imaging agent, data on several parameters must be known such as, but not limited to, dosimetry (physical, biological, and effective half-lives), biological characteristics (biodistribution and pharmacokinetics, degree of myocardial uptake and retention, the presence or not of myocardial redistribution, level of activity in the adjacent organs to the heart, and the relationship between myocardial uptake and coronary blood flow). In addition, the impact of a given imaging protocol on the overall diagnostic accuracy (sensitivity, specificity, the ability to detect the true extent and degree of perfusion defects, and appropriate results using either pharmacologic or exercise stress testing) must be evaluated. …