Purpose of Review

The most pertinent clinical question in post-coronary computed tomography angiography (CCTA) patients is the assessment of the physiological significance of an anatomically identified stenosis. The clinical application of radionuclide MPI using single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) in the evaluation and management of patients with an inconclusive CCTA is reviewed using a case-based approach.

Recent Findings

Recent evidence suggests that CCTA is the most sensitive non-invasive test to exclude angiographic CAD and may be an effective first-line test especially among symptomatic low-intermediate risk patients. However, in the presence of angiographic atherosclerosis, its specificity and positive predictive value for identifying flow-limiting stenosis are modest.

Summary

Radionuclide myocardial perfusion imaging offers accurate quantitative assessment of myocardial ischemia, which helps with risk stratification and patient management especially the potential need for revascularization. Routine accurate quantifications of myocardial blood flow and flow reserve are major advantages of PET MPI, which are especially useful when used in patients at intermediate-high clinical risk.

中文翻译：

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SPECT与PET心肌灌注成像对模棱两可的CT患者的比较。

审查目的

冠状动脉后计算机断层扫描血管造影（CCTA）患者中最相关的临床问题是对解剖学上确定的狭窄的生理意义的评估。使用基于案例的方法，回顾了使用单光子发射计算机断层扫描（SPECT）与正电子发射断层扫描（PET）进行放射性核素MPI在评估和治疗CCTA不确定的患者中的临床应用。

最近的发现

最近的证据表明，CCTA是排除血管造影CAD的最敏感的非侵入性检查，可能是有效的一线检查，尤其是在有症状的中低危患者中。然而，在存在血管造影动脉粥样硬化的情况下，其识别限流性狭窄的特异性和阳性预测价值是适度的。

概要

放射性核素心肌灌注成像可对心肌缺血进行准确的定量评估，这有助于进行风险分层和患者管理，尤其是可能需要进行血运重建。常规准确定量心肌血流和血流储备是PET MPI的主要优势，当用于中度高临床风险的患者时尤其有用。