Version July 2025
| PET | SPECT | |
| Stress modality | Pharmacologic* | Exercise or pharmacologic |
| Spatial resolution | ++++ | ++ |
| Radiotracer | 13N-ammonia, rubidium-82 | Technetium sestamibi (most common), thallium¶ |
| Radiation exposure | <5 msv | 5 to 20 msv (average 11 msv) |
| Cost | ++++ | ++ |
| Availability | Specialized centers | Widely available |
| Attenuation correction | All cases | Available with SPECT/CT systems |
| Imaging in large body habitus | Superior due to improved spatial resolution and attenuation correction | Two-day protocols (higher radiation exposure) Attenuation correction available with some systems |
| Assessment of multivessel disease | Assessment of coronary flow reserve improves the sensitivity of detecting multivessel coronary artery disease in cases with balanced ischemia | Perfusion defects could be underestimated due to balanced ischemia |
| Diagnostic certainty | Sensitivity 90%, specificity 80 to 90% Improved with incorporation of noncontrast CT and assessment of coronary flow reserve | Sensitivity and specificity 70 to 80% |
CT: computed tomography; PET: positron emission tomography; SPECT: single photon emission contrast tomography.
* Newer radiotracers in clinical trials, with longer half-life, would allow for exercise protocols compared with current U S Food and Drug Administration-approved PET tracers.
¶ Technetium sestamibi is most often used, but other technetium-based tracers are available.