Stress myocardial perfusion imaging for assessing prognosis: an update.

A strength of nuclear myocardial perfusion imaging (MPI) is the wealth of prognostic data accumulated over 30 years of experience with this technique. Nuclear MPI can predict outcomes and guide revascularization decisions in symptomatic patients and is well validated in special populations such as patients with diabetes and chronic renal disease. Known limitations, such as underestimation of ischemia and radiation burden, are being progressively reduced through advances such as positron emission tomography absolute flow quantification and fusion with computed tomography, new camera hardware and software, and stress-only protocols. Advanced statistical techniques and increasing focus on comparative effectiveness and appropriateness will continue to optimize nuclear cardiology going forward.