The updated 2026 American Society of Nuclear Cardiology (ASNC) Position Statement published in the Journal of Nuclear Cardiology concludes that cardiac PET myocardial perfusion imaging (MPI), particularly when combined with myocardial blood flow (MBF) quantification, should be the preferred noninvasive imaging modality for evaluating patients with suspected or known coronary artery disease (CAD), when available. This recommendation reflects the strong evidence accumulated since the 2016 position statement.
Key Recommendations
- PET MPI is now the preferred stress imaging test in major U.S. and European cardiology guidelines.
- Compared with SPECT, PET provides:
- Higher diagnostic accuracy
- Better risk stratification
- Superior image quality
- Quantitative myocardial blood flow assessment
- It is recommended for patients with stable or acute chest pain, enhanced cardiovascular risk assessment, and evaluation of coronary microvascular dysfunction.
Major Advantages of PET MPI
Superior Diagnostic Accuracy
PET detects obstructive CAD more accurately than SPECT and identifies multivessel disease, balanced ischemia, and coronary microvascular dysfunction, reducing unnecessary downstream testing.
Improved Risk Stratification
Perfusion imaging, MBF, ventricular function, and coronary artery calcium (CAC) each provide independent prognostic information, improving treatment decisions.
Quantitative Myocardial Blood Flow
PET is the gold standard for noninvasive MBF measurement. MBF quantification improves diagnostic accuracy, detects microvascular dysfunction and balanced ischemia, predicts future cardiovascular events, and guides decisions regarding revascularization and medical therapy.
Additional Benefits
PET performs well regardless of sex, obesity, coronary calcium burden, arrhythmias, implanted devices, or prior revascularization. It also offers rapid imaging, lower radiation exposure, and consistently excellent image quality.
Conclusion
The ASNC concludes that PET MPI with MBF quantification provides the most comprehensive noninvasive assessment of coronary artery disease, combining superior diagnostic accuracy, powerful risk stratification, quantitative physiologic information, excellent image quality, and low radiation exposure. Therefore, PET MPI should be the preferred myocardial perfusion imaging modality for all eligible patients whenever it is available.
Please ask your physician if this test is indicated for you.
