Beyond perfusion imaging

Excerpt

The birth of nuclear cardiology can be traced back to the introduction of myocardial perfusion imaging (MPI) in the early 1970s.¹ At the time, our understanding of coronary artery disease (CAD) pathophysiology was quite different from today, and despite multiple lines of evidence dating back to almost five decades, the role of coronary thrombosis in myocardial infarction (MI) was considered controversial.² Nearly 50 years later, it is well established that while the fixed stenosis detected by MPI underlies stable angina, acute coronary syndromes (ACS) typically arise from flow-limiting coronary thrombosis. There are different paths to coronary artery thrombosis; while plaque rupture is frequently the cause, plaque erosion plays an increasingly more important role in this process. Evaluation of myocardial perfusion, regardless of the imaging modality, can provide semi-quantitative information regarding the extent and severity of CAD, and is a reliable tool for CAD prognostication. Today, the field of nuclear cardiology continues to be defined by MPI. However, like any other thriving field, nuclear cardiology should evolve to incorporate new scientific discoveries, advances in technology, and changes in patient characteristics and needs. …