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  • Review Article
  • Published:

Integration of coronary anatomy and myocardial perfusion imaging

Nature Reviews Cardiology volume 7, pages 226–236 (2010)Cite this article

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Abstract

Advances in cardiovascular imaging have resulted in the development of multiple noninvasive techniques to evaluate myocardial perfusion and coronary anatomy, each of which has unique strengths and limitations. For example, CT angiography can directly visualize the presence of atherosclerosis, but the hemodynamic effect of many lesions identified by this technique is unknown. Alternatively, myocardial perfusion imaging enables a physiological assessment, but it may underestimate the extent of atherosclerosis in patients with multivessel disease. Dual-modality simultaneous imaging or multimodal sequential imaging techniques facilitate integration of information on both myocardial perfusion and coronary anatomy, and thus have the potential to improve diagnostic and prognostic evaluation, which could translate into improved care of patients. This Review discusses the strengths and limitations of the currently available individual noninvasive techniques for imaging coronary anatomy and myocardial perfusion. Approaches to integration of these imaging modalities are described, followed by an exploration of the clinical utility and future directions of hybrid imaging.

Key Points

  • Cardiac CT can directly visualize the presence of atherosclerosis and, if images are of sufficient quality, determine whether obstructive anatomical stenosis is present

  • Cardiac CT is an excellent technique for excluding obstructive coronary artery disease, but has a limited capacity to identify the presence of ischemia

  • Each of the techniques used for myocardial perfusion imaging has specific strengths and limitations, but PET is currently considered to be the most robust method for identifying and quantifying ischemia

  • The combination of coronary imaging and myocardial perfusion imaging offers many advantages, including the potential to improve diagnosis and predictions of prognosis

  • Although use of hybrid imaging techniques may improve therapeutic decision-making, issues relating to selection of patients, radiation exposure, and cost-effectiveness remain to be addressed

  • Rapid technical advances will further improve multimodality imaging and will pave the way for targeted molecular imaging

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Figure 1: Examples of images obtained by techniques used to assess coronary anatomy and myocardial perfusion.
Figure 2: Images obtained by cardiac CT.
Figure 3: Frequency of ischemia in vessels with ≥50% stenosis by CT angiography.
Figure 4: CT myocardial perfusion images.
Figure 5: PET and CT hybrid images obtained from a 60-year-old man with diabetes and hypertension undergoing investigation for chest pain.
Figure 6: CT and MRI hybrid image.

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Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Noninvasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, 02115, MA, USA

    Ron Blankstein & Marcelo F. Di Carli

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Blankstein, R., Di Carli, M. Integration of coronary anatomy and myocardial perfusion imaging. Nat Rev Cardiol 7, 226–236 (2010). https://doi.org/10.1038/nrcardio.2010.15

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