Myocardial Perfusion Imaging with SPECT-CT

  • Philipp A. Kaufmann


Noninvasive cardiac imaging has experienced substantial advances, including the introduction of coronary computed tomography angiography (CCTA). Invasive coronary angiography has remained the anatomic standard of reference but is associated with a nonnegligible periprocedural morbidity and mortality rate that suggests confining its use to patients who will benefit from a subsequent revascularization procedure. Many parameters beyond the simple quantification of luminal narrowing and which therefore cannot be fully assessed with luminology will determine whether a given lesion is hemodynamically relevant and causes stress-induced ischemia. Myocardial perfusion scintigraphy by single photon emission CT (SPECT) is the most widely used and best established noninvasive tool for diagnosing ischemic heart disease. Although positron emission tomography (PET) offers a higher accuracy than SPECT, its use is often limited to large centers. Latest results suggest a great potential of cardiac hybrid imaging, allowing a comprehensive evaluation of coronary artery disease (CAD) by combining both morphological and functional information after fusing SPECT with CCTA. Hybrid imaging with SPECT-CT can provide entirely noninvasively unique information that helps improve diagnostic assessment and risk stratification and also impacts decision making with regard to revascularization in patients with CAD.


Myocardial Perfusion Imaging Coronary Compute Tomography Angiography Invasive Coronary Angiography Myocardial Perfusion Scintigraphy Cadmium Zinc Telluride 


  1. 1.
    Achenbach S, Daniel WG (2001) Noninvasive coronary angiography — an acceptable alternative? N Engl J Med 345:1909–1910PubMedCrossRefGoogle Scholar
  2. 2.
    Shaw LJ, Shaw RE, Merz CN et al (2008) Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation 117:1787–1801PubMedCrossRefGoogle Scholar
  3. 3.
    Galbraith JE, Murphy ML, Desoyza N (1981) Coronary angiogram interpretation: interobserver variability. JAMA 240: 2053–2059CrossRefGoogle Scholar
  4. 4.
    White CW, Wright CB, Doty DB et al (1984) Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med 310:819–824PubMedCrossRefGoogle Scholar
  5. 5.
    Vlodaver Z, Frech R, Van Tassel RA, Edwards JE (1973) Correlation of the antemortem coronary arteriogram and the postmortem specimen. Circulation 47:162–169PubMedCrossRefGoogle Scholar
  6. 6.
    Patel MR, Peterson ED, Dai D et al (2010) Low diagnostic yield of elective coronary angiography. N Engl J Med 362:886–895PubMedCrossRefGoogle Scholar
  7. 7.
    Schroeder S, Achenbach S, Bengel F et al (2008) Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J 29:531–556PubMedCrossRefGoogle Scholar
  8. 8.
    Bartunek J, Sys SU, Heyndrickx GR et al (1995) Quantitative coronary angiography in predicting functional significance of stenoses in an unselected patient cohort. J Am Coll Cardiol 26:328–334PubMedCrossRefGoogle Scholar
  9. 9.
    Klocke FJ, Baird MG, Lorell BH et al (2003) ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging — executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation 108:1404–1418PubMedCrossRefGoogle Scholar
  10. 10.
    Smith SC, Dove JT, Jacobs AK et al (2001) ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol 37:2215–2239PubMedCrossRefGoogle Scholar
  11. 11.
    Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 31:2501–2555PubMedCrossRefGoogle Scholar
  12. 12.
    Underwood SR, Anagnostopoulos C, Cerqueira M et al (2004) Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging 31:261–291PubMedCrossRefGoogle Scholar
  13. 13.
    Kapur A, Latus KA, Davies G et al (2002) A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study. Eur J Nucl Med Mol Imaging 29:1608–1616PubMedCrossRefGoogle Scholar
  14. 14.
    Herzog BA, Buechel RR, Husmann L et al (2010) Validation of CT attenuation correction for high-speed myocardial perfusion imaging using a novel cadmium-zinc-telluride detector technique. J Nucl Med 51:1539–1544PubMedCrossRefGoogle Scholar
  15. 15.
    Buechel RR, Pazhenkottil AP, Herzog BA et al (2010) Realtime breath-hold triggering of myocardial perfusion imaging with a novel cadmium-zinc-telluride detector gamma camera. Eur J Nucl Med Mol Imaging 37:1903–1908PubMedCrossRefGoogle Scholar
  16. 16.
    Herzog BA, Buechel RR, Katz R et al (2010) Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: optimized protocol for scan time reduction. J Nucl Med 51:46–51PubMedCrossRefGoogle Scholar
  17. 17.
    Namdar M, Hany TF, Koepfli P et al (2005) Integrated PET/CT for the assessment of coronary artery disease: a feasibility study. J Nucl Med 46:930–935PubMedGoogle Scholar
  18. 18.
    Gaemperli O, Kaufmann PA (2008) Hybrid cardiac imaging: more than the sum of its parts? J Nucl Cardiol 15:123–126PubMedCrossRefGoogle Scholar
  19. 19.
    Gaemperli O, Schepis T, Kaufmann PA (2007) SPECT-CT fusion imaging integrating anatomy and perfusion. Eur Heart J 28:145CrossRefGoogle Scholar
  20. 20.
    Gaemperli O, Schepis T, Valenta I et al (2007) Cardiac image fusion from stand-alone SPECT and CT: clinical experience. J Nucl Med 48:696–703PubMedCrossRefGoogle Scholar
  21. 21.
    Husmann L, Herzog BA, Gaemperli O et al (2009) Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur Heart J 30:600–607PubMedCrossRefGoogle Scholar
  22. 22.
    Hachamovitch R, Hayes SW, Friedman JD et al (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 107:2900–2907PubMedCrossRefGoogle Scholar
  23. 23.
    Shaw LJ, Berman DS, Maron DJ et al (2008) Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117:1283–1291PubMedCrossRefGoogle Scholar
  24. 24.
    Boden WE, O’Rourke RA, Teo KK et al (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516PubMedCrossRefGoogle Scholar
  25. 25.
    Gaemperli O, Schepis T, Valenta I et al (2008) Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology 248:414–423PubMedCrossRefGoogle Scholar
  26. 26.
    Marcassa C, Delaloye AB, Cuocolo A et al (2006) The regulatory background of nuclear cardiology in Europe: a survey by the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging 33:1508–1512PubMedCrossRefGoogle Scholar
  27. 27.
    van Werkhoven JM, Schuijf JD, Gaemperli O et al (2009) Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 53:623–632PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Philipp A. Kaufmann
    • 1
  1. 1.Department of Radiology, Cardiac ImagingUniversity Hospital ZurichZurichSwitzerland

Personalised recommendations