SPECT quantification of myocardial blood flow: A journey of a thousand miles begins with a single step (Lao Tzu, Chinese philosopher, 604-531 BC)

Excerpt

There is increasing evidence for the incremental diagnostic and prognostic value of myocardial blood flow (MBF) quantification over conventional relative myocardial perfusion imaging (MPI). Measurement of stress and rest MBF on an absolute scale (mL/min/g) together with the derived ratio of stress/rest flow reserve (MFR) can help to avoid the accepted under-estimation of the extent and severity of disease observed using conventional relative-scale MPI. Improved detection of multi-vessel and micro-vascular disease has been demonstrated with stress MBF and MFR imaging, mainly using dynamic PET with ⁸²Rb or ¹³N-ammonia tracers. Despite these significant advantages, PET imaging is not as widely available as SPECT, which remains the clinical work-horse in nuclear cardiology for the diagnosis and management of patients with obstructive coronary artery disease (CAD). …