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Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia.

  • Dewey M Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. dewey@charite.de.
  • Siebes M Department of Biomedical Engineering and Physics - Translational Physiology, Amsterdam University Medical Center, Amsterdam, Netherlands.
  • Kachelrieß M Division of X-Ray Imaging and CT, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
  • Kofoed KF The Heart Centre Rigshospitalet, Department of Cardiology and Radiology, University of Copenhagen, Copenhagen, Denmark.
  • Maurovich-Horvat P MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
  • Nikolaou K Universitätsklinikum Tübingen, Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Tübingen, Germany.
  • Bai W Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK.
  • Kofler A Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Manka R Institute of Diagnostic and Interventional Radiology and Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
  • Kozerke S Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
  • Chiribiri A Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • Schaeffter T Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • Michallek F Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Bengel F Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany.
  • Nekolla S Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
  • Knaapen P Department of Cardiology, VU University Medical Center, Amsterdam, Netherlands.
  • Lubberink M Department of Surgical Sciences - Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden.
  • Senior R Department of Cardiology, Royal Brompton Hospital London, London, UK.
  • Tang MX Department of Bioengineering, Imperial College London, London, UK.
  • Piek JJ Heart Center, Amsterdam University Medical Center, Amsterdam, Netherlands.
  • van de Hoef T Heart Center, Amsterdam University Medical Center, Amsterdam, Netherlands.
  • Martens J Department of Cellular and Molecular Imaging, Comprehensive Heart Failure Center, Würzburg University Clinics, Würzburg, Germany.
  • Schreiber L Department of Cellular and Molecular Imaging, Comprehensive Heart Failure Center, Würzburg University Clinics, Würzburg, Germany.
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  • 2020-02-26
Published in:
  • Nature reviews. Cardiology. - 2020
Delphi Technique
Echocardiography
Humans
Magnetic Resonance Imaging
Myocardial Ischemia
Myocardial Perfusion Imaging
Positron-Emission Tomography
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
English 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.
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  • English
Open access status
hybrid
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https://sonar.ch/global/documents/98883
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