Myocardial Perfusion Imaging

Ischemic heart disease (IHD) is the leading cause of death for men and women worldwide, and it also causes substantial disability and loss of productivity. The diagnosis of IHD involves clinical evaluation, including identifying risk factors, and specific cardiac investigations such as stress testing or coronary artery imaging. The arsenal of imaging modalities to detect and manage patients with IHD is large: Coronary computed tomography angiography, myocardial perfusion scintigraphy (MPS), positron emission tomography (PET), stress echocardiography, and cardiac magnetic resonance imaging. In this chapter we cover the nuclear medicine tests MPS and PET. Pathophysiology of IHD and indications of the tests are described. The procedures of both MPS and PET include a test at stress and at rest, and images are acquired. The chapter also covers reconstruction and reorientation of images, as well as evaluation of images, both quantitatively and qualitatively. Testing for ischemia by non-invasive imaging is not expected to decrease – rather the opposite, since exercise tests are no longer generally recommended for diagnosing ischemia. Also, the prevalence of IHD is increasing. Therefore, good knowledge of state-of-the-art cardiac nuclear medicine techniques are essential for medical physicists.