The role of myocardial perfusion imaging in the diagnosis of patients with coronary artery disease: developments over the past year

PURPOSE OF REVIEW: The role of myocardial perfusion imaging in the diagnosis of coronary artery disease in various patient populations has been expanding. Recent literature from March 2004 to February 2005 has advanced the concept of attenuation correction and electrocardiographic gating in improving the diagnosis of coronary artery disease. RECENT DEVELOPMENTS: The American Heart Association encourages the use of electrocardiographic-gated single photon emission computerized tomography in women. Asymptomatic diabetic patients may benefit from screening with myocardial perfusion imaging. Dobutamine stress perfusion imaging is an important diagnostic tool in elderly patients who are unable to exercise. In patients with chest pain, acute imaging may decrease unnecessary admissions. Vasodilator stress imaging has high sensitivity and specificity in patients with left bundle branch block. Patients undergoing endovascular stent grafting may benefit from risk stratification with vasodilator myocardial perfusion imaging. The American Society of Nuclear Cardiology and the Society of Nuclear Medicine have recognized the role of attenuation correction in increasing the diagnostic accuracy of myocardial perfusion imaging. Multiple studies emphasize the importance of electrocardiographic gating in myocardial perfusion imaging. SUMMARY: Recent developments have resulted in an important statement by the American Heart Association that assigns a larger role for myocardial perfusion imaging in the diagnosis of coronary artery disease in women. The role of myocardial perfusion imaging is also expanding in various other patient populations. The literature has validated the concept of attenuation correction for the accurate assessment of attenuation artifacts as well as electrocardiographic gating in enhancing the diagnosis and risk stratification for coronary artery disease.