Cardiac imaging has a pivotal role in the prevention, diagnosis and treatment of ischaemic
heart disease. SPECT is most commonly used for clinical myocardial perfusion imaging,
whereas PET is the clinical reference standard for the quantification of myocardial
perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography,
which can be performed at the bedside. CT perfusion imaging is not frequently used
but CT offers coronary angiography data, and invasive catheter-based methods can measure
coronary flow and pressure. Technical improvements to the quantification of pathophysiological
parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations
on the appropriateness of each technique were derived following a European quantitative
cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors
allows the quantification of myocardial blood flow and is now also suited to patients
with a high BMI. PET is well suited to patients with multivessel disease to confirm
or exclude balanced ischaemia. MRI allows the evaluation of patients with complex
disease who would benefit from imaging of function and fibrosis in addition to perfusion.
Echocardiography remains the preferred technique for assessing ischaemia in bedside
situations, whereas CT has the greatest value for combined quantification of stenosis
and characterization of atherosclerosis in relation to myocardial ischaemia. In patients
with a high probability of needing invasive treatment, invasive coronary flow and
pressure measurement is well suited to guide treatment decisions. In this Consensus
Statement, we summarize the strengths and weaknesses as well as the future technological
potential of each imaging modality. Cardiac imaging has a pivotal role in the prevention,
diagnosis and treatment of ischaemic heart disease. In this Consensus Statement, the
authors summarize the use of SPECT, PET, MRI, echocardiography, CT and invasive coronary
flow and pressure measurement, and describe the relative strengths and weaknesses
of each modality.
