EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

Abstract

Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf .

Keywords: Guidelines; Myocardial perfusion imaging; Nuclear medicine; Procedures.

Fig. 1

Selection of stress test modality. Except for patients with left bundle branch block (LBBB) or ventricular paced rhythm, consider combining pharmacological vasodilatory stress with low-level exercise according to the ability of the patient to exercise. In case of pharmacological stress with dobutamine but without adequate heart rate response, consider to add atropine

Fig. 2

Timeline of regadenoson plus low-level exercise testing. BPM beats per minute

Fig. 3

Coronary artery territories in a 17-segment model Myocardial perfusion SPECT, coronary computed tomography angiography (CCTA), and fused hybrid SPECT/CCTA of a 43-year-old male patient with presenting symptoms of typical angina. Myocardial perfusion SPECT documents a reversible perfusion defect in short axis and horizontal long axis slices (a) at rest (bottom rows) and stress (top rows). The corresponding polar plots (b) at rest (left plot) and stress (right plot) clearly depict the extent of the ischaemic area in the anterolateral wall. CCTA (c) shows an intermediate stenosis (i.e., 50–70 % luminal narrowing) due to non-calcified plaques in the middle/distal left anterior descending artery at the level of the second diagonal branch bifurcation. Fused hybrid SPECT/CCTA (d) reveals that the anterolateral ischaemia corresponds with the vascular territory of the second diagonal branch, while the stenosis in the left anterior descending artery (LAD) does not cause any ischaemia