Table A Advantages and Limitations of Imaging Modalities
Test Modality | Advantages |
|---|---|
Echocardiography | Can evaluate valve disease, diastolic parameters, pulmonary hypertension, myocardial diseases, pericardial disease. Can be performed with pharmacological or exercise stress |
SPECT | Can be performed with pharmacological vasodilation or pharmacological/exercise stress |
PET | Can quantify peak myocardial blood flow and myocardial blood flow reserve, which improve diagnosis and prognostication and may allow for detection of microvascular disease |
CMR | Can assess wall motion, ischemia, and infarction in one study. Can quantify myocardial blood flow to improve test accuracy and assess myocardial and pericardial diseases. Can perform viability testing |
CAC | Can detect the presence and amount of calcified coronary plaque; robust prognostic value; does not require a contrast agent |
CCTA | Can detect both nonobstructive and obstructive plaque. Can identify noncardiac causes for some symptoms. CT stress perfusion and CT FFR can assess for ischemia |
Invasive angiography | Can detect both nonobstructive and obstructive plaque. Can perform physiological testing using FFR or nonhyperemic indices, intravascular imaging (eg, IVUS/OCT), additional testing for coronary spasm and microvascular disease, and adjunctive hemodynamic assessments (eg, right and left heart catheterization) |
Test Modality | Limitations |
Echocardiography* | Limited acoustic windows (COPD, obesity, breast implants) |
SPECT* | Attenuation, motion, and soft tissue artifacts may underestimate extent of disease. Exposure to radiation |
PET* | Not widely available with exercise. Exposure to radiation |
CMR* | Claustrophobia, artifacts, and safety precautions with metallic medical devices |
CCTA | Reduced quality may be present in patients with morbid obesity, high or irregular heart rates, or severe coronary calcification. Exposure to radiation |
Invasive angiography | Procedural complications. Exposure to radiation |