Place actuelle et perspectives futures de la scintigraphie de perfusion myocardique

Myocardial perfusion scintigraphy (MPS) is a well-established tool for coronary artery disease (CAD) detection and prognostic evaluation. By detecting viable myocardium in hypoperfused territories and assessing physiological significance of intermediate coronary stenosis after catheterization, MPS can help for decision-making. Electocardiogram (ECG) gated single photon emission computerized tomography (SPECT), bringing informations about left ventricular global function and segmental wall motion, has increased MPS diagnostic accuracy and offers additive and independent prognostic value. Nowadays, many improvements are in progress. Some, like new vasodilator agents as selective adenosine A2a receptor agonists might seem trivial, but others are more challenging. Indeed, the development of new SPECT detectors based on cadmium zinc telluride crystals or the availability of rubidium-82 generators for positron emission tomography (PET) will lead to increased spatial resolution, high sensitivity and time-saving imaging procedures. Moreover, integrated PET-CT systems allow efficient attenuation correction and offer the possibility for absolute quantification of myocardial blood flow. At last, the interest of combinating functional and anatomical data thanks to hybrid SPECT-CT or PET-CT scans will have to be evaluated.