Return of dual-isotope SPECT myocardial perfusion imaging? Not so fast…

Excerpt

Myocardial perfusion imaging remains the most frequently used non-invasive modality for the detection and risk stratification of patients with obstructive epicardial coronary artery disease (CAD). From its inception more than 40 years ago, the mode of stressing, choice of radioactive tracers, and detection technology, have evolved: From exercise stress alone to a choice of four pharmacological stressors, from thallium-201 (Tl-201) to technetium-99m (Tc-99m) tracers, from planar to SPECT imaging, from single head to dual-head cameras, from Na-I crystals to CZT solid state cameras. Despite the long track record of diagnostic accuracy, prognostic robustness and ubiquitous availability, continued success for the modality cannot be taken for granted. With competition from the emergence of other non-invasive modalities (stress echocardiography, cardiac CT angiography, cardiac MRI) and with documented changes in the clinical manifestations of CAD,1,2 the demands on the safety, efficiency, and convenience of myocardial perfusion imaging continue to grow. …