Diagnosis of coronary artery disease by radionuclide myocardial perfusion imaging.

D espite advances in the understanding of the pathophysiology of atherosclerosis and an applaudable reduction in cardiovascular mortality over the past 30 years, coronary artery disease (CAD) remains an important cause of mortality and morbidity in the UK. While primary prevention of CAD is a priority for modern medicine, so too is the need for development of non-invasive techniques for imaging of myocardial ischaemia. Radionuclide tests occupy a central position within the cardiac imaging portfolio, and among them myocardial perfusion imaging (MPI) has an obvious place because it is the only widely available and validated method of assessing myocardial perfusion. The aim of this article is to review the literature about the role of tomographic MPI in the diagnosis of CAD in the general population and in specific clinical subsets, comparing it wherever possible with other imaging modalities and to summarise the recommendations from existing guidelines for the use of this technique.