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SPECT is most commonly used for clinical myocardial perfusion imaging, whereas PET is the clinical reference standard for the quantification of myocardial perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography, which can be performed at the bedside. CT perfusion imaging is not frequently used but CT offers coronary angiography data, and invasive catheter-based methods can measure coronary flow and pressure. Technical improvements to the quantification of pathophysiological parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations on the appropriateness of each technique were derived following a European quantitative cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors allows the quantification of myocardial blood flow and is now also suited to patients with a high BMI. PET is well suited to patients with multivessel disease to confirm or exclude balanced ischaemia. MRI allows the evaluation of patients with complex disease who would benefit from imaging of function and fibrosis in addition to perfusion. Echocardiography remains the preferred technique for assessing ischaemia in bedside situations, whereas CT has the greatest value for combined quantification of stenosis and characterization of atherosclerosis in relation to myocardial ischaemia. In patients with a high probability of needing invasive treatment, invasive coronary flow and pressure measurement is well suited to guide treatment decisions. In this Consensus Statement, we summarize the strengths and weaknesses as well as the future technological potential of each imaging modality.<\/jats:p>","DOI":"10.1038\/s41569-020-0341-8","type":"journal-article","created":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T17:07:26Z","timestamp":1582564046000},"page":"427-450","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":173,"title":["Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia"],"prefix":"10.1038","volume":"17","author":[{"name":"on behalf of the Quantitative Cardiac Imaging Study Group","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4402-2733","authenticated-orcid":false,"given":"Marc","family":"Dewey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7034-5843","authenticated-orcid":false,"given":"Maria","family":"Siebes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Kachelrie\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9742-1554","authenticated-orcid":false,"given":"Klaus F.","family":"Kofoed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0885-736X","authenticated-orcid":false,"given":"P\u00e1l","family":"Maurovich-Horvat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Nikolaou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2943-7698","authenticated-orcid":false,"given":"Wenjia","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kofler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Manka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kozerke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3394-4289","authenticated-orcid":false,"given":"Amedeo","family":"Chiribiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Schaeffter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Michallek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Bengel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Nekolla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Knaapen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lubberink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxy","family":"Senior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Xing","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan J.","family":"Piek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"van de Hoef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Martens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8827-1838","authenticated-orcid":false,"given":"Laura","family":"Schreiber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,24]]},"reference":[{"key":"341_CR1","doi-asserted-by":"publisher","first-page":"2949","DOI":"10.1093\/eurheartj\/eht310.P4876","volume":"34","author":"G Montalescot","year":"2013","unstructured":"Montalescot, G. et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 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M.D. reports further grant support from the Berlin Institute of Health\u2019s Digital Health Accelerator program; F.M. is partially employed through this program. Institutional master research agreement grants with Siemens Healthineers, Philips Medical Systems and Canon Medical Systems exist at Charit\u00e9, which are handled by the legal department. M.D. reports grants from the FP7 Program of the European Commission for the DISCHARGE project, grants from DFG and the German Ministry of Education and Research (BMBF) for individual patient data meta-analyses on cardiac imaging, honoraria for speaking from Bayer, Canon, Cardiac MR Academy Berlin and Guerbet, royalties as an editor of <i>Cardiac CT<\/i> published by Springer, and organization of Charit\u00e9 hands-on courses on cardiac CT imaging. M.D. and T.S. are also principal investigators of the BIOQIC graduate programme at Charit\u00e9, which is funded by the DFG; A.K. is a PhD student in this graduate programme. M.S. received institutional support from the University of Texas Health Science Center at Houston for the DEFINE-FLOW project (NCT02328820). W.B. is supported by the SmartHeart EPSRC Program Grant (EP\/P001009\/1). T.S and A.C. report grant support from the EMPIR project 15HLT05 PerfusImaging. F.B. reports grant support and speaker honoraria from GE Healthcare and Siemens AG. S.N. receives research funding from the DFG, Horizon2020 and Siemens Healthineers. M.L. is supported by grants and speaker honoraria from GE Healthcare and is a co-founder of MedTrace Pharma AS. M.-X.T. reports grant support from the UK EPSRC (EP\/M011933\/1) and the British Heart Foundation (PG\/16\/95\/32350). J.J.P. and T.v.d.H. report serving as speakers at educational events organized by Boston Scientific, Philips-Volcano and St. Jude Medical (now Abbott Vascular), which are manufacturers of sensor-equipped guide wires. J.M. and L.S. report grants from the BMBF (01EO1504, 01EO1504) and Siemens Healthineers, Germany. The other authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}