Myocardial Perfusion Imaging Interpretation Report

Facility: [facility name and location]

Patient: [name], [MRN], [DOB], [sex]

Height/Weight: [height and weight as documented]

Study Date: [date] | Report Date: [date]

Ordering Provider: [name]

Study Type: [SPECT MPI / PET MPI]; [rest-stress / stress-only / pharmacologic protocol]; [CTAC if performed]

Clinical Context

[Indication for study]. [Pertinent cardiac history affecting interpretation] (Include only if materially affecting interpretation: prior MI/PCI/CABG, cardiomyopathy, baseline conduction abnormalities limiting ECG ischemia assessment.) [Relevant medications or preparation status] (Include only if clinically significant: beta-blockers held/continued, caffeine status for vasodilator stress.) [Comparison study date and brief summary, or state "No prior study available for comparison."]

Stress Protocol and Response

• Stress: [exercise protocol name OR pharmacologic agent/dose with low-level exercise if combined]; [duration]; [reason for termination]; [achieved workload in METs and/or % max predicted HR as applicable]
• Hemodynamics: [rest HR/BP] → [peak HR/BP] (If unavailable, state "not recorded" and note the resulting limitation.)
• Symptoms: [presence/absence and type]; [resolution in recovery]; [aminophylline if used]
• ECG: [baseline rhythm and conduction]; [baseline ST-T abnormalities]; [stress-induced ST changes and arrhythmias] (Explicitly state if ECG ischemia assessment is non-diagnostic due to baseline abnormalities.)
• Adequacy: [adequate / submaximal] stress (If submaximal, note potential sensitivity limitation.)
• Adverse Events: [description if occurred, otherwise state "None"]

Technique and Quality

• Radiotracer: [agent name], [rest activity], [stress activity] (Note suspected extravasation if applicable.)
• Protocol: [rest/stress imaging performed]; [ECG gating: stress / rest / both]; [attenuation correction: CTAC / none]; [additional positioning if used: prone / delayed]
• Image Quality: [excellent / good / fair / poor]; [diagnostic / limited / non-diagnostic]. [Artifacts present with location and impact on interpretation] (If no significant artifacts, state "No significant artifacts; study is diagnostic.")

Findings

Perfusion: [global summary: normal / abnormal / equivocal with reason]. [For each abnormality: location using AHA 17-segment terminology and/or wall regions with optional coronary territory, extent, severity, type, and interpretation label with justification]. [Quantitative metrics if available: SSS/SRS/SDS, % LV ischemia]. [High-risk markers assessed: TID, increased lung uptake, stress-induced LV cavity dilation—state presence or absence explicitly].

LV Function: [LVEF %] (If compromised, state "EF not reliable due to [reason]."); [global function: normal / mildly reduced / moderately reduced / severely reduced / hyperdynamic]; [LV size: normal / enlarged]. [Regional wall motion abnormalities] (Include only if present; reconcile with perfusion findings.) [Post-stress EF drop or new wall motion abnormality if observed].

Ancillary Findings: (Include only if CTAC performed.) [CT images reviewed for extracardiac findings]; [limitations of low-dose CT]; [clinically significant incidental findings requiring follow-up, or state "No actionable extracardiac findings."]

PET Myocardial Blood Flow

(Include this section ONLY when PET MBF/MFR quantification was performed; omit entirely otherwise.)

• QC Statement: [dynamic data quality adequate for quantification: motion correction, ROI placement, CT-PET registration] (If unreliable, state "MBF quantification not reliable—values not reported" with reason, and omit numeric values entirely.)
• Results: (Include only if QC adequate.) [Global MBF rest], [Global MBF stress] (mL/min/g), [Global MFR]; [Regional MFR by territory: LAD / LCx / RCA if available]
• Interpretation: [Concordance or discordance with visual perfusion findings]. (If pattern suggests microvascular dysfunction or diffuse disease with normal relative perfusion, state as "suggestive" and recommend clinical correlation.)

Impression

1. [Study type] study, [diagnostic / limited / non-diagnostic] (State primary limiting factor if limited or non-diagnostic.)
2. Perfusion: [normal with no inducible ischemia] OR [abnormal: extent, location, and interpretation]
3. LV Function: [EF % and category]; [stress-induced changes if present]
4. High-Risk Features: [presence or absence of TID, severe ischemic burden, reduced global MFR if PET MBF performed]
5. Comparison: [unchanged / improved / worsened] compared to [prior study date], or "No prior study available for comparison."
6. Recommendation: [additional evaluation if warranted by findings or limitations] (Include only if warranted; do not dictate management. Omit if no recommendation needed.)

(Do not claim specific coronary stenoses from perfusion findings alone. Use "probable" language only when justified in Findings.)

Interpreting Physician: [name, credentials, signature, date/time]