Choosing the Appropriate Stress Test for Myocardial Perfusion Imaging

Purpose of ReviewChoosing the most appropriate test or protocol to ensure patient safety along with accurate and informative results can be challenging. The aim of this article is to review important considerations when choosing a nuclear stress perfusion study.Recent FindingsSingle-photon emission computed tomography (SPECT) has a sensitivity of 70% and a specificity of 78% for the diagnosis of coronary artery disease (CAD), and positron emission tomography (PET) has a sensitivity of 90% and specificity of 88%. The addition of either SPECT or PET to cardiac-gated computed tomography (CCTA) confers an increase in specificity when compared to CCTA alone, at the cost of a lower sensitivity.SummarySPECT sets itself aside because of its relative low cost and easy accessibility. PET has a superior diagnostic performance and lower radiation exposure, but is less available and relatively more expensive for most clinicians. When ordering a nuclear stress perfusion test, the type of protocol and radiotracers used should be tailored to achieve the best overall accuracy and prognostic assessment with the lowest radiation dose achievable.