Radionuclide myocardial perfusion imaging for the evaluation of patients with known or suspected coronary artery disease in the era of multimodality cardiovascular imaging.

Over the last several decades, radionuclide myocardial perfusion imaging (MPI) with single photon emission tomography and positron emission tomography has been a mainstay for the evaluation of patients with known or suspected coronary artery disease (CAD). More recently, technical advances in separate and complementary imaging modalities including coronary computed tomography angiography, computed tomography perfusion, cardiac magnetic resonance imaging, and contrast stress echocardiography have expanded the toolbox of diagnostic testing for cardiac patients. While the growth of available technologies has heralded an exciting era of multimodality cardiovascular imaging, coordinated and dispassionate utilization of these techniques is needed to implement the right test for the right patient at the right time, a promise of "precision medicine." In this article, we review the maturing role of MPI in the current era of multimodality cardiovascular imaging, particularly in the context of recent advances in myocardial blood flow quantitation, and as applied to the evaluation of patients with known or suspected CAD.