Myocardial perfusion scintigraphy using rubidium-82 positron emission tomography

Introduction: Myocardial perfusion scintigraphy (MPS) is an established noninvasive technique for the diagnosis and management of patients with suspected or known coronary artery disease. Because of the wealth of prognostic data, MPS single photon emission computed tomography (SPECT) is the most commonly used functional test to detect inducible ischaemia. However, the increasing availability of positron emission tomography (PET) scanners for oncology along with the introduction of the generator-produced PET tracer rubidium-82 (Rb-82) has helped the growth of MPS PET. Sources of data: Relevant review articles, primary literature and clinical guidelines identified through medical literature search engines. Areas of agreement: PET offers advantages over SPECT, including increased patient throughput because of rapid scanning protocols, reduced radiation exposure to patients and the ability to quantify tracer distribution accurately and hence measure myocardial perfusion in millilitre per gram per minute and hence myocardial perfusion reserve (MPR). Areas of controversy: Although PET has advantages over SPECT, there are no large-scale prognostic or cost-effectiveness data to support it use as the primary MPS technique. Growing points: Awider use of absolute measurements of perfusion has the potential to improve diagnostic accuracy and to add prognostic value over relative assessment of myocardial perfusion. Areas timely for developing research: Assessment of absolute myocardial perfusion may provide insight into the effects of traditional risk factors on perfusion reserve and the impact of risk factor modifications on progression of coronary artery disease.