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| | Advantages | Limitations |
|
| PET | (i) Modality of choice for absolute myocardial perfusion quantification.
(ii) Superior to SPECT in spatial and temporal resolution, image quality and diagnostic accuracy.
(iii) Can be performed in patients with pacemakers or implantable cardioverter defibrillator. | (i) High cost.
(ii) Radiation exposure.
(iii) Not much available ⟶ more suitable in research setting then in clinical practice. |
|
| SPECT | (i) Radionuclides are easier to prepare, less expensive and have longer half-lives compared to PET ⟶ more suitable in daily clinical routine.
(ii) High SE and high SP for detection of ischaemia.
(iii) Allows evaluation of LV function.
(iv) Very useful for risk stratification.
(v) Provides important prognostic information in different clinical settings, especially in stable CAD. | (i) Radiation exposure.
(ii) Relatively high cost and time consuming.
(iii) Limited information regarding anatomy due to low spatial resolution.
(iv) Photon attenuation artefacts (particularly in obese subjects) may produce FP.
(v) In patients with multivessel disease, SPECT may underestimate the true extent of disease (balanced reduction in myocardial hyperaemic blood flow not detectable by semi-quantitative analysis) ⟶ prefer other modalities in patients with higher pre-test likelihood of multivessel CAD. |
|
| MRI | (i) Not require ionizing radiation.
(ii) Higher SE and SP for detection of ischaemia than SPECT.
(iii) High spatial resolution.
(iv) Allows evaluation of LV function
(v) Multiparametric imaging technique ⟶ strong role in differentiate ischaemic from non-ischaemic cardiac diseases.
(vi) Provides important prognostic information. | (i) Time-consuming image acquisition
(ii) Limited availability
(iii) Lack of widespread expertise
(iv) Common cardiac devices as pacemakers, implantable defibrillators, etc.. are still considered a contraindication to CMR.
(v) Claustrophobia.
(vi) Heart rate and respiratory motion artefacts. |
|
| ECHO | (i) Radiation-free.
(ii) Rapid and safe ⟶suitable technique as a first- line approach.
(iii) Can be performed at the bedside.
(iv) Less expensive than other modalities.
(v) Provides simultaneous evaluation of perfusion and function in real time.
(vi) Allows assessment of many non-ischemic cardiac diseases.
(vii) MCE with microbubbles has superior spatial/temporal resolution and SE compared to SPECT. | (i) Poor thoracic window in at least 10% of patients.
(ii) Operator and reader dependence.
(iii) Artifacts. |
|
| CTP | (i) Provides integrated anatomic and functional evaluation in a single examination.
(ii) Very fast exam.
(iii) Widely available.
(iv) High sensitivity and high specificity.
(v) Superior submillimetre spatial resolution with respect to SPECT⟶ detection of smaller, especially subendocardial, perfusion defects.
(vi) Allows evaluation of important non-coronary cardiac findings.
(vii) Provides important prognostic information. | (i) Radiation exposure, especially for dynamic CTPI (but still lower than nuclear imaging)
(ii) Breath and beam hardening artifacts.
(iii) High heart rate artifacts. |
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