Myocardial perfusion imaging in the diagnosis of coronary artery disease

The role of myocardial perfusion imaging has been extended from diagnosis to management and prognosis in patients with coronary artery disease. Great emphasis has been placed on improving the accuracy of the test to better define perfusion, viability, and the extent of damage of the myocardium. To achieve this goal, investigators have focused on several areas including imaging technique, in which the accuracy of single-photon emission CT has been compared with that of positron emission tomography; radiopharmaceuticals, in which 201Tl has been compared with 99mTc-sestamibi and 99mTc-teboroxime; stress modalities, in which dipyridamole and adenosine stress have been compared with exercise; myocardial viability, as determined by delayed and reinjection 201Tl imaging or by measurement of cellular integrity using 82Rb compared with 18fluorodeoxyglucose metabolic PET imaging; and assessment of myocardial salvage and prognosis by exercise or dipyridamole 201Tl imaging in acute myocardial infarction.