Nuclear medicine: non-invasive evaluation of coronary artery disease

Non-invasive evaluation of coronary artery disease is accomplished in Nuclear Medicine by resting and exercise right and left ventriculography and/or by myocardial perfusion studies performed also at rest and exercise by means of Thallium-201. The development of new radiopharmaceuticals such as ultra short-lived radionuclides and Technetium-99m labelled myocardial imaging agents allow simultaneous evaluation of both left ventricular function and left ventricular myocardial perfusion. Myocardial perfusion imaging is performed by means of planar imaging and recently by means of single photon emission tomography. The sensitivity and specificity of stress left ventriculography for uncomplicated coronary artery diseases are 85% and 95% respectively. For diagnosis of acute myocardial infarction with Thallium-201 in the first hours after onset of pain, the sensitivity is 99% and specificity is 80%. This diminishes after a 6 hour period to 90% and 80% respectively, while wall motion analysis stays with a sensitivity of 79% and 93%. The prognostic value of this determination is therefore a strong, cost-effective contributor to the non-invasive evaluation of coronary artery disease.