Introduction: The increasing number of available cardiac imaging techniques has made the investigation of coronary artery disease (CAD) more complex. Appropriate patient referral depends on an understanding of the pre-test likelihood of CAD and the information provided by each test.
Sources of data: This article describes myocardial perfusion scintigraphy (MPS) and summarizes evidence for its role in stable CAD and acute coronary syndromes with particular reference to current guidelines.
Areas of agreement: MPS has been extensively validated for the cost-effective diagnosis and prognosis of functionally significant CAD in both the acute and chronic settings. Its use is emphasized in the current NICE, national and international guidelines.
Areas of controversy: Although normal MPS is associated with good outcomes, assessments of subclinical atherosclerosis such as coronary artery calcium scoring and computed tomography coronary angiography (CTA) demonstrate that non-flow-limiting CAD remains prognostically important.
Growing points: Technological developments, such as attenuation correction to improve diagnostic accuracy or analysis of left ventricular phase to detect dyssynchrony, carry the possibility of increasing the information that can be usefully gained from a single MPS study.
Areas timely for developing research: Of particular importance will be the role of MPS in an integrated imaging strategy that involves both anatomical and functional cardiac assessments. The use of hybrid technology that combines techniques such as MPS and CTA into a single imaging unit requires careful consideration with regard to diagnostic usefulness and cost-effectiveness.