Nuclear Cardiology in the Diagnosis and Management of Coronory Artery Disease

Coronary artery disease (CAD) is a coronary artery narrowing or occluding disorder that could end up with myocardial infarction or death due to atherosclerosis. A complete assessment of CAD requires both anatomical and functional information. The clinical scenario is most often the deciding factor between anatomical and functional imaging. Anatomical imaging is most helpful to exclude disease in asymptomatic or low likelihood patients, whereas functional imaging is most helpful in symptomatic patients. Myocardial perfusion scintigraphy (MPS) is one of the most frequently used functional modalities with high diagnostic accuracy and level of evidence, allowing reliable risk stratification and guiding the selection of patients for further interventions. Normal stress MPS findings strongly indicate the absence of coronary obstruction and hence of clinically significant disease. Another noninvasive modality is cardiac positron emission tomography (PET) providing additional information for quantitative myocardial blood flow, coronary flow reserve, and viability. The combination of cardiac single photon emission tomography or PET with computed tomography increases the diagnostic accuracy of the test especially with improvements in specificity and could decrease the number of incompletely evaluated patients. Recently developed PET/magnetic resonance (MR) hybrid imaging, apart from lack of ionizing radiation of MR component, provides data related to soft tissue and plaque biology. Developments in radiopharmaceuticals, hardware, and software give hope that nuclear imaging modalities will be more frequently used for diagnosis, follow-up, and treatment evaluation in CAD. Identification of subclinical coronary artery atherosclerosis to enhance primary prevention of CAD, acute myocardial Koroner arter hastal (KAH) ateroskleroz nedeni ile ileri evrede miyokard infarkts veya lm ile sonulanabilen, koroner arterlerin daralmas veya tkanmasdr. KAH'nin tam olarak deerlendirilmesi iin hem anatomik hem de fonksiyonel bilgiye ihtiya vardr. Anatomik ve fonksiyonel grntleme seiminde klinik senaryo sklkla belirleyici faktrdr. Anatomik grntleme en ok asemptomatik veya dk riskli olgularda hastal dlamada yardmc iken, fonksiyonel deerlendirme daha ok semptomatik hastalarda nemlidir. Fonksiyonel grntleme yntemlerinden miyokard perfzyon sintigrafisi (MPS), yksek tansal doruluu ve kant dzeyi ile risk belirleme ve sonraki uygulamalar iin hasta seiminde yol gsterici olmas nedeni ile en sk kullanlan yntemlerdendir. Normal MPS bulgular hemodinamik anlaml koroner arter darl ve klinik anlaml hastaln olmadnn gl