My opinion

By Dr. Thomas F Heston
Corresponding Author Dr. Thomas F Heston
Internet Medical Association, 848 N Rainbow Blvd #1289 - United States of America
Submitting Author Dr. Thomas F Heston
Nuclear Medicine

Myocardial Perfusion Imaging, Coronary Artery Disease, Nuclear Cardiology

Heston TF. Stress-only Nuclear Myocardial Perfusion Imaging. WebmedCentral Nuclear Medicine 2012;3(7):WMC003049
doi: 10.9754/journal.wmc.2012.003049

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 23 Jul 2012 05:03:15 AM GMT
Published on: 23 Jul 2012 01:43:11 PM GMT


Inducible myocardial ischemia from coronary artery disease is diagnosed when blood flow to the heart at stress is significantly less than blood flow at rest. The identification of inducible ischemia is important in people with chest pain, because with proper treatment the risk of a major adverse cardiac event is greatly reduced. Many different conditions can cause chest pain, most of which are benign and non-life threatening. However, inducible ischemia can be life threatening, and when left untreated the consequences are severe.

One of the best and most thoroughly validated method of testing for inducible ischemia is stress-rest myocardial perfusion gated SPECT imaging. This involves injecting a patient with a radiotracer at rest and during peak stress. The radiotracer is primarily designed to map blood flow to the heart. However, using a gated SPECT protocol also allows determination of left ventricular size, wall motion, and ejection fraction. Inducible ischemia is suggested by abnormalities in any of these imaging variables at stress, that are not present at rest. Because the objective is to identify abnormalities at stress that are not present at rest, current utilization guidelines for myocardial perfusion gated SPECT recommend imaging both at rest and immediately post-stress.

Newer research in myocardial perfusion imaging has looked at the possibility of imaging patients only post-stress, and omitting the rest scan. The reasoning for this is that if the stress scan is normal, then the rest scan is medically unnecessary, financially costly, and exposes patients to excess radiation. Although not yet widely validated, stress-only imaging may be reasonable in low-risk patients as long as any abnormal stress study is followed-up with a rest scan. Nevertheless, at the current time, clinical practice guidelines have not fully addressed or endorsed stress-only imaging, and nearly all nuclear cardiology clinics continue to perform stress-rest imaging.

There are several reasons for continuing the practice of stress-rest imaging until more research is done. One reason is that myocardial perfusion imaging is not indicated in low-risk patients, so the research doesn't apply to clinical medicine. The research protocols for stress-only imaging typically involved attenuation correction SPECT, a technique that has not been widely accepted due to a relative lack of solid evidence supporting its use. Another reason is that risk stratification prior to imaging is often inexact, so it is medically safer to assume at least an intermediate risk and perform a stress-rest study. Finally, the goal of myocardial perfusion imaging is to maximize sensitivity, since the consequences of failing to identify inducible ischemia can be severe. Stress-only imaging is not thought to be as sensitive as stress-rest imaging.


The current prevailing medical practice to perform stress-rest imaging as a routine appears to be clinically appropriate, with a recent clinical update (2009) from the American Society of Nuclear Cardiology concluding that a stress-only strategy "does not yet have sufficient data to support a widespread utilization." Nevertheless, the research supporting stress-only imaging continues to grow, with one recent paper finding its use even in high-risk patients to be appropriate in some circumstances.


1. Heller G, Hendel R. Nuclear Cardiology: Practical Applications, Second Edition [2010].
2. Des Prez RD, Dahlberg ST, Einstein AJ et al. Stress-only myocardial perfusion imaging [2009]

Source(s) of Funding


Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

0 reviews posted so far

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)