Overview of stress radionuclide myocardial perfusion imaging
- Panithaya Chareonthaitawee, MD
Panithaya Chareonthaitawee, MD
- Associate Professor of Medicine
- Mayo Clinic College of Medicine
- J. Wells Askew, MD
J. Wells Askew, MD
- Assistant Professor of Medicine
- Mayo Clinic College of Medicine
- Section Editors
- Patricia A Pellikka, MD, FACC, FAHA, FASE
Patricia A Pellikka, MD, FACC, FAHA, FASE
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine
- Mayo Clinic College of Medicine
- Gary V Heller, MD, PhD, FACC, MASNC
Gary V Heller, MD, PhD, FACC, MASNC
- Section Editor — Noninvasive Cardiac Imaging
- Division of Cardiovascular Medicine Morristown Medical Center
Radionuclide myocardial perfusion imaging (rMPI) enables evaluation of cardiac perfusion and function at rest and during dynamic exercise or pharmacologic stress for the diagnosis and management of patients with known or suspected coronary heart disease. Radionuclide MPI requires the administration of a radioactive perfusion tracer (also called a radiopharmaceutical or radioisotope), usually intravenously, and a special camera system, single-photon emission computed tomography (SPECT), or positron emission tomography (PET), to detect the gamma photons. Myocardial perfusion images are usually acquired at rest and following stress, with increasing adoption of stress-only imaging, and many available combinations of one- versus two-day rest-first versus stress-first protocols, as discussed below. A specialized computer program reconstructs the acquired images into standard displays (image 1).
Radionuclide MPI provides important information on rest and post-stress myocardial perfusion, viability, and global and regional left ventricular systolic function, which generally signify the presence and extent of underlying coronary artery disease. In addition, rMPI is a powerful tool for risk stratification of patients with known or suspected coronary artery disease.
Resting rMPI provides information on the presence or absence of myocardial infarction and viability. To detect the presence and extent of myocardial ischemia, a radioisotope must also be administered under conditions of stress, and rest and stress images can then be compared. Stress testing in conjunction with rMPI is accomplished using either exercise (treadmill or bicycle), pharmacologic agents (preferably vasodilators, but if contraindicated, dobutamine), or a combination of both vasodilator stress and low-level exercise.
An overview of the indications, contraindications, techniques, and safety of stress rMPI will be provided here (table 1). Exercise treadmill testing and stress echocardiography, as well as the advantages and disadvantages of stress rMPI as compared with other stress modalities, are discussed separately. (See "Exercise ECG testing: Performing the test and interpreting the ECG results" and "Overview of stress echocardiography" and "Stress testing for the diagnosis of obstructive coronary heart disease" and "Selecting the optimal cardiac stress test".)
There are several established indications for stress radionuclide myocardial perfusion imaging (rMPI) [1-3]:
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- STRESS TECHNIQUES
- Choice of stress method
- Exercise rMPI
- Pharmacologic rMPI
- - Vasodilator rMPI
- Mechanism of vasodilator stress
- Relative flow differences
- Vasodilator agents
- - Adenosine
- - Dipyridamole
- - Selective A2A receptor agonists
- - Safety and comparison of vasodilators
- - Addition of exercise
- - Dobutamine rMPI
- IMAGING TECHNIQUES
- SPECT imaging
- - SPECT isotopes
- - SPECT protocols
- Single-isotope rest/stress protocol
- Single-isotope, stress-only protocol
- Dual isotope
- PET imaging
- - PET isotopes
- Radiation exposure
- SUMMARY AND RECOMMENDATIONS