Arq Bras Cardiol: Imagem cardiovasc. 2023; 36(1): e363
How Can the Assessment of Myocardial Flow Reserve by Nuclear Medicine Change the Interpretation of Myocardial Perfusion Scintigraphy?
Myocardial perfusion scintigraphy (MPS) with single-photon emission computed tomography (SPECT) is important for the diagnosis and prognostic evaluation in patients with coronary artery disease (CAD). MPS evaluates the presence, extent and degree of myocardial ischemia and/or infarction, usually through visual observation or semi-quantitative parameters. Despite its proven diagnostic and prognostic values, the relative nature of perfusion imaging may limit SPECT ability to identify patients with high-risk multivessel CAD. Limitations regarding visual or semi-quantitative assessment of regional myocardial perfusion defects may result in underestimation or misdiagnosis due to “balanced” ischemia.
This limitation can be addressed by quantifying myocardial blood flow (MBF) or myocardial flow reserve (MFR) using tracer kinetics in positron emission tomography (PET). , PET is a well-validated non-invasive method for quantification of myocardial perfusion, demonstrating an incremental diagnostic and prognostic power compared to MPS in patients with suspected or known CAD. , PET then is considered the gold standard for non-invasive quantification of MBF and MFR. – However, the production of PET tracers is costly and the technology is not yet available in many countries.
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Keywords: Coronary Artery Disease; Diagnosis; Scintigraphy
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