Assessment of myocardial viability using single-photon emission computed tomography myocardial perfusion imaging

PURPOSE OF REVIEW: The assessment of myocardial viability continues to be a pressing and sometimes challenging clinical question. Among other imaging modalities proven to be useful in the assessment of myocardial viability, single-photon emission computed tomography (SPECT) instrumentation and expertise continue to be the most widely available to the practicing physicians. Understanding the utility of SPECT myocardial perfusion imaging in this domain is an enduring need. RECENT FINDINGS: A wealth of basic science and clinical data established the value of a variety of Tl-201 and Tc-99m SPECT protocols in the assessment of myocardial viability. The diagnostic performance for Tl-201 and Tc-99m imaging protocols for identifying viable myocardium is very good and is comparable for both agents. Quantitative assessment of radiotracer uptake can predict, in an objective manner, the probability of recovery of myocardial function following revascularization. SUMMARY: SPECT myocardial perfusion imaging with Tl-201 and Tc-99m tracers can provide an objective and quantifiable assessment of myocardial viability, which can help predict the likelihood of myocardial function recovery following coronary revascularization. Effective application of this imaging technique can guide clinical decision-making for coronary revascularization.