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The Clinical Value of MPI

The Clinical Value of MPI

The Diagnostic and Prognostic Value of MPI

Considerations for the MPI Modalities and Your Patient

When a patient’s pretest probability of CAD is intermediate to high, myocardial perfusion imaging (MPI) may be an appropriate modality for risk stratification and patient management.1

Two MPI modalities are SPECT MPI and positron emission tomography (PET) MPI. Either can be used to identify ischemia and prior infarction, risk stratify patients with known or suspected CAD, and guide clinical management decisions regarding medical therapy or revascularization.2 There are some differences between these modalities that should be considered when selecting the right modality for the right patient.


1. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol 2012;60(24):e44-164. Erratum in: J Am Coll Cardiol 2014;63(15):1588-90. 2. Dorbala S, Di Carli MF. Nuclear cardiology. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier Inc, 2022. 3. Driessen RS, Raijmakers PG, Stuijfzand WJ, Knaapen P. Myocardial perfusion imaging with PET. Int J Cardiovasc Imaging 2017;33(7):1021-31. 4. Bateman TM, Heller GV, McGhie AI, et al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: Comparison with ECG-gated Tc-99m sestamibi SPECT. J Nucl Cardiol 2006;13(1):24-33. 5. Abbott BG, Case JA, Dorbala S, et al. Contemporary cardiac SPECT imaging—innovations and best practices: an information statement from the American Society of Nuclear Cardiology. J Nucl Cardiol 2018;25(5):1847-60. 6. Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: stress, protocols, and tracers. J Nucl Cardiol 2016;23(3):606-39. Erratum in: J Nucl Cardiol 2016;23(3):640-2. 7. DePuey EG, Mahmarian JJ, Miller TD, et al. Patient-centered imaging. J Nucl Cardiol 2012;19(2):185-215. Erratum in: J Nucl Cardiol 2012;19(3):633. 8. Dorbala S, Ananthasubramaniam K, Armstrong IS, et al. Single photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpretation. J Nucl Cardiol 2018;25(5):1784-846.

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