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Quantitative myocardial perfusion imaging across PET, SPECT, CMR, and CT

Yoko Kato1, Omar Chehab1, Bharath Ambale-Venkatesh2

  • 1Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States.

Frontiers in Radiology
|April 2, 2026
PubMed

Insights

Myocardial perfusion imaging (MPI) is crucial for diagnosing coronary artery disease (CAD) and other heart conditions. Advances in PET, CMR, and CT enable quantitative myocardial blood flow (MBF) assessment, improving diagnostic and prognostic capabilities.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Techniques

Background:

  • Coronary computed tomography angiography (CCTA) trials have shifted focus from functional testing.
  • Myocardial perfusion imaging (MPI) remains vital for specific patient groups, including those with suspected coronary artery disease (CAD), microvascular dysfunction, and cardiomyopathies.

Purpose of the Study:

  • To review the physiological principles, acquisition, and post-processing strategies for MPI.
  • To discuss the clinical relevance and future perspectives of quantitative MPI across various imaging modalities.

Main Methods:

  • Review of current literature on positron emission tomography (PET), cardiovascular magnetic resonance (CMR), computed tomography (CT), and Single Photon Emission Computed Tomography (SPECT) for MPI.
  • Focus on absolute quantification of myocardial blood flow (MBF).

Main Results:

  • Advances in PET, CMR, and CT allow for absolute quantification of myocardial blood flow (MBF).
  • Quantitative MPI offers improved diagnostic and prognostic performance compared to traditional methods.

Conclusions:

  • Quantitative MPI is essential for a comprehensive assessment of myocardial perfusion in diverse cardiovascular conditions.
  • There is a need to reappraise the role of MPI in light of technological advancements and new clinical trial data.

Keywords:
absolute myocardial blood flowcardiac magnetic resonance (CMR)computed tomography (CT)myocardial perfusion imaging (MPI)pixel-wise quantificationpositron emission tomography (PET)quantitativesingle-photon emission computed tomography (SPECT)

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