Current and future trends in multimodality imaging of coronary artery disease

Abstract

Nowadays, there is a wide array of imaging studies available for the evaluation of coronary artery disease, each with its particular indications and strengths. Cardiac single photon emission tomography is mostly used to evaluate myocardial perfusion, having experienced recent marked improvements in image acquisition. Cardiac PET has its main utility in perfusion imaging, atherosclerosis and endothelial function evaluation, and viability assessment. Cardiovascular computed tomography has long been used as a reference test for non-invasive evaluation of coronary lesions and anatomic characterization. Cardiovascular magnetic resonance is currently the reference standard for non-invasive ventricular function evaluation and myocardial scarring delineation. These specific strengths have been enhanced with the advent of hybrid equipment, offering a true integration of different imaging modalities into a single, simultaneous and comprehensive study.

Non-invasive assessment of low- and intermediate-risk patients with chest pain

“…Navare et al [21] found that exercise stress MPI and pharmacological stress MPI have comparable ability to diagnose and risk stratify patients when used accordingly. Stress MPI provides excellent diagnostic accuracy for CAD with sensitivity and specificity of 87–89% and 70–79%, respectively [22]. The average sensitivity and specificity for the detection of CAD is 88% and 69%, and for exercise MPI and for adenosine MPI, 90% and 81%, respectively.…”

“…In addition, artifacts secondary to breast tissue, respiratory motion or sub-diaphragmatic attenuation are known to occur. Techniques such as attenuation correction has allowed for improvements in characterization of perfusion defections by reducing artifacts created by surrounding tissue particularly in women and obese patients [22,30,31]. …”

“…CCTA has demonstrated rapid development as a cardiac imaging modality for the assessment of coronary artery disease with advancements from early generation 4- and 16-slice to 64- and now 320-slice scanners [22,30,31]. The sensitivity and specificity of CCTA is 82–99% and 89–98% [22], with a high negative predictive value of >90% making it a preferred modality to rule out CAD in low- and intermediate-risk patients [35]. …”

“…Thus, the diagnostic utility of CCTA is limited in particular patient populations where the degree of stenosis cannot be assessed. These subgroups include older patients due to coronary calcification, or those with chronic kidney disease or prior coronary stents [22,30]. Radiation exposure is an important limitation of CCTA as a cardiac imaging modality; however, studies have shown effective strategies that reduce radiation dose while maintaining adequate assessment of the coronary anatomy [45,46].…”

“…Radiation exposure is an important limitation of CCTA as a cardiac imaging modality; however, studies have shown effective strategies that reduce radiation dose while maintaining adequate assessment of the coronary anatomy [45,46]. Additional disadvantages include limited availability and reduced image quality in the presence of arrhythmias or increased heart rate [22,30]. …”