Table 1.

Specificities of imaging modalities and respective advantages/disadvantages

	Specificities in women relevant to the respective imaging modality	Advantages in women	Disadvantages in women
Cardiac CT	- Higher heart rate - Less non-obstructive CAD - Less calcified plaques - Less high-risk plaque features - Smaller diameter of epicardial coronary arteries - Angina for lower degrees of coronary stenosis - FFR-CT higher in women than in men for given stenosis severity	- Calcium scoring: higher sensitivity in women - CCTA: imaging of positive remodeling, a differential diagnosis of non-obstructive CAD - Early detection of plaques and subsequent increase in preventive therapies - Information about plaque composition - Measurement of CT perfusion and FFR-CT - Reduced need for additional testing and costs in women with angina	- Radiation exposure (0.5–7 mSv) - Lower sensitivity and specificity for detection of stable CAD than in men - Lower image quality due to smaller size of epicardial coronary arteries
CMR	- Small left ventricular cavity size in postmenopausal women - T1 and ECV mapping values higher in women than in men - In pregnant women, adapt position to left lateral tilt position	- Devoid of radiation exposure; possible during the 2nd and 3rd trimester of pregnancy - Simultaneous assessment of cardiac volumes, function, and perfusion - Mapping techniques to detect edema and fibrosis - Measurement of GLS to detect CTRCD - Higher sensitivity than SPECT-MPI for stable CAD - Differential diagnosis of MINOCA/INOCA	- Higher rates of side effects of vasodilator agents for stress perfusion CMR - Fetal risk induced by heating effect during 1st trimester of pregnancy - Fetal risk related to gadolinium at any stage of pregnancy - Higher frequency of claustrophobia in women
SPECT	- Small left ventricular cavity size in postmenopausal women - Breast tissue	- High accuracy for detection of myocardial ischemia - Wide availability - If combined SPECT/CT, possible correction of breast attenuation artifacts - If combined SPECT/CT, possible simultaneous quantification of CACS	- Highest radiation exposure of all noninvasive imaging modalities (2–8 mSv) - Higher rates of side effects of vasodilator agents - Small heart artifact - Breast attenuation artifact - No diagnosis of CMVD - Risk of false negatives for small ischemic areas - Underestimation of LVEF value compared to CMR - Excretion of radiotracer in maternal milk: interruption of breastfeeding for > 12 h
PET	- Higher values of MBF at rest - CFR values lower in women than in men	- Reference standard for the quantification of MBF and CFR - High spatial resolution - Correction of breast attenuation artifacts	- Radiation exposure (2–5 mSv) - No routine measurement of cardiac volumes - Excretion of radiotracer in maternal milk: interruption of breastfeeding for > 12 h

Abbreviations. CACS: coronary artery calcium score; CAD: coronary artery disease; CCTA: coronary computed tomography angiography; CMR: cardiac magnetic resonance; CMVD: coronary microvascular dysfunction; CFR: coronary flow reserve; CT: computed tomography; CTRCD: cancer treatment-related cardiac dysfunction; ECV: extracellular volume; FFR: fractional flow reserve; GLS: global longitudinal strain; INOCA: ischemia with no obstructive coronary artery disease; LVEF: left ventricular ejection fraction; MBF: myocardial blood flow; mSv: milliSievert; MINOCA: myocardial infarction with no obstructive coronary artery disease; MPI: myocardial perfusion imaging; PET: positron emission tomography; SPECT: single-photon emission computed tomography