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 |
CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; COPD = chronic obstructive pulmonary disease; CT = computed tomography; FFR = fractional flow reserve; IVUS = intravascular ultrasound; OCT = optical coherence tomography; PET = positron emission tomography; SPECT = single-photon emission computed tomography
*Vasodilator testing is contraindicated if caffeine was used within the last 12 h; stress testing is contraindicated when there is high-risk unstable angina or acute MI (< 2 days)