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Myocardial perfusion scintigraphy: technical innovations and evolving clinical applications
  1. Constantinos Anagnostopoulos1,2,
  2. Johanne Neill3,
  3. Eliana Reyes4,
  4. Elizabeth Prvulovich3
  1. 1Nuclear Medicine Division, Clinical Research Centre, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
  2. 2Department of Nuclear Medicine, Barts and The London NHS trust, London, UK
  3. 3Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  4. 4National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Constantinos Anagnostopoulos, Nuclear Medicine Division, Clinical Research Centre, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou Street, Athens 11527, Greece; cdanagnostopoulos{at}bioacademy.gr

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Introduction

Myocardial perfusion scintigraphy (MPS) with single photon emission CT (SPECT) has served the cardiology community for almost three decades. Significant developments have taken place over recent years covering almost every aspect of the technique. This article describes the technical innovations in scanners, software, imaging protocols and stress regimens and discusses its evolving clinical role.

History

Planar MPS was introduced in the 1970s. Two decades later, most centres have adopted SPECT with ECG gating for the combined assessment of myocardial perfusion and left ventricular function using thallium-201, technetium-99m-sestamibi or technetium-99m-tetrofosmin. Over the past few years MPS has evolved from a diagnostic test of high accuracy for the detection of coronary artery disease (CAD) (mean sensitivity and specificity 90% and 75%, respectively) to an important tool for risk stratification, for which a large body of evidence exists documenting its clinical value and cost-effectiveness in a broad range of patient subgroups.1–3 Recent innovations in the field are likely to enhance the value of MPS even further. Here we discuss the most important of these new developments.

Recent technological developments

A new generation of cameras has been developed that exhibits a remarkably high sensitivity compared with conventional gamma camera systems. These are steady-state ‘small-footprint’ cameras that use new cadmium zinc telluride (CZT) detector technology. In contrast to traditional sodium iodide (NaI) detectors, CZT detectors can translate photon energy and location directly into electronic pulses without the need for photomultiplication of scintillation events. The D-SPECT camera (Spectrum Dynamics, Caesarea, Israel) comprises nine rotating pixilated detector columns of …

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