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The future of myocardial perfusion imaging

Non-Invasive Imaging

This session was dedicated to the current practice and the future possibilities of myocardial perfusion imaging using different modalities.
Paul Knaapen (Amsterdam, Netherlands) started with PET- MPI. He reported on the advantage of quantitative perfusion imaging in comparison with qualitative methods, used by the other modalities. The data base is growing, indicating very good diagnostic accuracy and low radiation exposure, depending on the tracers used. He foresees a bright future for PET- MPI, especially, when new and more stable tracers become available.
Alessia Gimelli (Pisa, Italy) reported on SPECT- MPI. The limitation of this technique in the past was the radiation exposure, which could be overcome in part by the development of a new camera- generation with a substantial reduction in exposure. The major advantage of SPECT is the large data base and the extensive clinical experience. In the second part of her talk, she put the focus on myocardial-innervation- imaging using MIPG. She pointed out its potential for more accurate risk stratification in patients with impaired left ventricular function. An interesting and promising avenue for further research.
Sven Plein (Leeds, UK) presented the data of MR- MPI. The advantage of MRI is the lack of ionizing radiation and of iodinated contrast agents. Because of its high in-plane spatial resolution (the 3D- resolution is lower), images of high quality can be obtained, in case of stress MR of hyperaemic myocardial blood flow. The comparison with nuclear methods is promising. As a limitation, he pointed out the large variation in image acquisition and quantification protocols.
Stephan Achenbach (Erlangen, Germany) summarized the data of CT- MPI. Because of its high spatial and temporal resolution, cardiac CT is mainly used for morphologic coronary imaging. As shown by nice image examples, additionally also perfusion defects can be detected within the same data set, when reconstructing the myocardium with thicker slices (e.g. 10 mm). This is considered as “add on” information to the visualization of the coronaries. Currently, stress CT- MPI is also evaluated in clinical research and he showed dedicated stress and scan protocols. Also CT- FFR is feasible. Its accuracy is, however, at present unclear and currently being evaluated by different studies.
In summary, a very interesting session with excellent presentations by dedicated experts in their fields and with a vivid discussion. The review of the slides on “ESC Congress 365” is recommendable.




The future of myocardial perfusion imaging

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.