Abstract
The primary clinical applications of positron emission tomography (PET) myocardial perfusion imaging are to diagnose, localize, and quantify the severity of coronary artery stenoses. As a result, most clinical applications of myocardial perfusion imaging are performed in conjunction with stress testing. Exercise stress testing with single photon emission computed tomography (SPECT) is widely used in the evaluation of patients with known or suspected coronary artery disease.1–3 Although exercise stress testing offers several advantages, the short physical half-life of most PET radiotracers makes it logistically impractical for use in conjunction with PET imaging. In addition, a significant proportion of patients referred for stress imaging are unable to exercise adequately due to difficulties with ambulation related to prior stroke, peripheral vascular disease, orthopedic problems or deconditioning.3 Submaximal exercise can reduce test sensitivity for detection of ischemic heart disease and should be avoided. Pharmacologic stress testing with dipyridamole,4,5 adenosine4,6,7 or dobutamine infusions8–9 are useful to evaluate patients that are unable to exercise or have suboptimal exercise capicity.3 Chapter 9 provides a detailed discussion of stress protocols. The aim of this chapter is to provide a review of clinically useful imaging protocols for evaluation of CAD, along with guidelines for quality control of PET and PET/CT images. For a better understanding of protocols for PET myocardial perfusion imaging, the reader should be familiar with basic principles of PET and PET/CT (discussed in Chapters 1 and 3) and PET radiopharmaceuticals (discussed in Chapter 5).
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