Mini-review examines myocardial perfusion imaging advances across PET, SPECT, CMR, and CT modalities

This systematic mini-review synthesizes evidence on the physiological principles, acquisition strategies, and clinical relevance of myocardial perfusion imaging (MPI) across PET, SPECT, CMR, and CT modalities. The population of interest includes patients with known or suspected coronary artery disease (CAD), microvascular dysfunction, ischemia with normal coronary arteries (INOCA), coronary anomalies, and cardiomyopathies. The review does not report a specific sample size, comparator, primary outcome, or follow-up duration.

The main findings indicate that recent clinical trials have demonstrated the prognostic value of coronary computed tomography angiography (CCTA). The review reports that advances in PET, CMR, and CT enable absolute quantification of myocardial blood flow (MBF), providing improved diagnostic and prognostic performance. However, it finds the incremental prognostic benefit of ischemia-guided revascularization over optimal medical therapy to be limited. No specific effect sizes, absolute numbers, p-values, or confidence intervals are reported for these outcomes.

Safety and tolerability data are not reported. Key limitations of the evidence are not detailed in the provided input. The review's practice relevance centers on a suggested need to reappraise myocardial perfusion imaging. Given the nature of a mini-review and the lack of reported quantitative data, the findings should be interpreted as a high-level synthesis of existing evidence rather than a definitive clinical guide.