New technical developments in nuclear cardiology and hybrid imaging

Author(s):  
Antti Saraste ◽  
Sharmila Dorbala ◽  
Juhani Knuuti

Cardiac hybrid imaging offers the ability to combine strengths of different imaging modalities in providing information on cardiac physiology along with cardiac and coronary anatomy. Hybrid images contain two data sets combined into a fused image in which both data sets contribute important information. Hybrid coronary computed tomography angiography and nuclear or magnetic resonance myocardial perfusion imaging has been shown to accurately detect coronary artery disease. Emerging clinical applications of cardiac hybrid imaging include evaluation of myocardial viability, cardiac or vascular inflammation, infection, and cardiac infiltration. Cardiac dedicated single photon emission computed tomography scanners, novel software methods for low count image reconstruction, and quantification of myocardial blood flow by positron emission tomography (PET) have potential to lower radiation dose associated with cardiac imaging while maintaining high diagnostic accuracy for the detection of coronary artery disease.

Cardiology ◽  
2015 ◽  
Vol 133 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Mathias Sørgaard ◽  
Jesper James Linde ◽  
Klaus Fuglsang Kofoed ◽  
Jørgen Tobias Kühl ◽  
Henning Kelbæk ◽  
...  

Objectives: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. Methods: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. Results: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). Conclusions: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.


ESC CardioMed ◽  
2018 ◽  
pp. 556-560
Author(s):  
Amita Singh ◽  
Noreen Nazir ◽  
Victor Mor-Avi ◽  
Amit R. Patel

Coronary computed tomography angiography (CTA) has been widely adopted as a non-invasive tool for the evaluation of coronary artery disease. Given its high negative predictive value, it is an accurate modality to rule out obstructive coronary artery disease in the setting of chest pain. While the sensitivity and derived negative predictive value of coronary CTA are excellent, the specificity and positive predictive value are lower due to the difficult image interpretation in the presence of heavy coronary calcification, stents, coronary bypass grafts, motion artefacts, and arrhythmias. Vasodilator computed tomography myocardial perfusion (CTP) is an emerging technique with the ability to identify myocardial segments perfused by haemodynamically significant coronary stenoses. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CTP in comparison to a number of reference standards, including single-photon emission computed tomography, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow reserve testing. This chapter summarizes the current state of CTP.


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