From Detector Innovation to Clinical Practice: A Comprehensive Review of CZT-SPECT in Coronary Artery Disease Imaging

Abstract: Cadmium-Zinc-Telluride (CZT) detector-based Single Photon Emission Computed Tomography (SPECT) represents a paradigm shift in Myocardial Perfusion Imaging (MPI), overcoming major limitations inherent to conventional Anger-type systems, including prolonged acquisition times and constrained quantitative functionality. The cardiac-optimized CZT platform enables rapid image acquisition with reduced radiation burden while achieving enhanced diagnostic precision through superior spatial resolution and photon sensitivity. Clinical evidence demonstrates superior performance in detecting hemodynamically significant Coronary Artery Disease (CAD) compared to traditional SPECT, coupled with quantitative assessment of myocardial blood flow and flow reserve, which strengthens risk stratification and prognostic capability. This technology supports personalized clinical management through improved detection of subclinical ischemia and protocol optimization for radiation reduction. Integration with advanced attenuation/scatter correction methodologies enhances prognostic discrimination, enabling robust differentiation between low-risk and high-risk patient cohorts for Major Adverse Cardiac Events (MACEs). Persistent challenges, including motion-related artifacts and protocol standardization, are being addressed through innovations in data-driven motion correction, next-generation detector architectures, collimators, and hybrid imaging system integration. As the field of cardiovascular imaging evolves, CZT-SPECT stands as a transformative modality that optimally balances operational efficiency, patient safety, and diagnostic confidence. Continued technological refinement and rigorous clinical validation will solidify its position as an indispensable tool for guiding precision interventions and optimizing CAD management pathways.