Cadmium-zinc-telluride myocardial perfusion imaging: The dream of a single test gets nearer

Hybrid anatomo-functional imaging of coronary artery disease: Beneficial irrespective of its core components

“…[16][17][18][19][20] The advent of Alcyone technology-based solid-state cadmium-zinc-telluride (CZT) detectors, thanks to heightened spatial and energy resolution, increases sensitivity and specificity as well as acquisition time (\ 3 minutes) and effective radiation dose (\ 3 mSv). 21 This new-generation camera has many advantages in comparison to Anger cameras: increased specificity, more precise quantification of ischemia severity, quantitative appraisal of coronary flow reserve (CFR), heightened sensitivity in recognizing patients with multivessel disease, easier identification of the culprit lesion, more accurate measurement of ventricular geometry (end-diastolic and mass) and function (stress/rest), dual isotope imaging (e.g., Tl and MIBG), and integrated SPECT/CTA imaging.…”

“…In addition, hybrid imaging may be exploited to appraise coronary plaque pathophysiology, 23 atherothrombotic burden, 57 and risk of instability, 58 as well as myocardial inflammation, apoptosis, and dysinnervation. 21 Indeed, several key elements for successful implementation and use hybrid imaging should be borne in mind. First, when appraising stenoses of similar angiographic severity (e.g., 70% diameter stenosis), it is paramount to be able to distinguish lesions which have impaired coronary reserve and thus impact unfavorably on prognosis in comparison to those which have preserved coronary reverse and thus do not confer a prognostic disadvantage, and hybrid imaging is ideally equipped to do it.…”

Bridging the Atlantic gap in clinical guidelines for non-ST-elevation acute coronary syndromes

“…12 Myocardial perfusion imaging (MPI) remains a powerful test in NSTEACS for its ease, access, reliability, and thus may maintain a dominating role among the available cardiac imaging tests. 1,2,[13][14][15] Yet, virtually all institutions have no 24/7 access to MPI. In addition, in very high-and high-risk patients, MPI is not useful for diagnostic purposes or short-term prognosis as diagnosis is already quite established and accordingly the indication to invasive management.…”

“…4,7 For instance, CT-derived anatomic imaging, which provides for instance details on lesion location, plaque features, vessel remodeling, calcium score, and stenosis severity can be seamlessly combined with MPI-derived functional imaging, which yields several functional parameters provided by MPI, including, most recently, coronary flow reserve. 6,[13][14][15] Thus, hybrid imaging provides many important results which are complementarily associated with pre-test and stress features, enabling the best clustering of the patient into a low-risk group, or otherwise prompting expedited invasive assessment, or guiding postdischarge management and follow-up.…”

“…1,2,15 Yet, individualized management requires also careful and proactive follow-up. Indeed, the importance of the quest for optimal care shortly and long-after discharge for an otherwise correctly managed NSTEACS is proven by ongoing efforts at improving and streamlining patient empowerment, interactive follow-up, and patient-physician communication with novel information technology platforms such as the Recipe tools developed by Replycare (Rome, Italy).…”