Abstract
Cardiac positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) are encouraging precise non-invasive imaging modalities that allow imaging of the cellular function of the heart, while other non-invasive cardiovascular imaging modalities are considered to be techniques for imaging the anatomy, morphology, structure, function and tissue characteristics. The role of cardiac PET has been growing rapidly and providing high diagnostic accuracy of coronary artery disease (CAD). Clinical cardiology has established PET as a criterion for the assessment of myocardial viability and is recommended for the proper management of reduced left ventricle (LV) function and ischemic cardiomyopathy. Hybrid PET/CT imaging has enabled simultaneous integration of the coronary anatomy with myocardial perfusion and metabolism and has improved characterization of dysfunctional areas in chronic CAD. Also, the availability of quantitative myocardial blood flow (MBF) evaluation with various PET perfusion tracers provides additional prognostic information and enhances the diagnostic performance of nuclear imaging.
Highlights
Despite considerable advances in prevention and management of atherosclerotic heart disease and its devastating consequences, the morbidity and mortality of coronary artery disease (CAD) [1]in developed countries remains high [2]
A recent study, performed by Namdar et al, estimated the prognostic value of FDG-positron emission tomography (PET)/computed tomography (CT) in elderly patients with stable coronary artery disease (CAD) and reduced left ventricular ejection fraction before revascularisation. This positron emission tomography/computed tomography (PET/CT) study revealed that FDG PET/CT detected viable myocardium was associated with better clinical outcomes tracer uptake in myocardium at the high flow rates
Previous studies have disclosed that SPECT perfusion imaging can detect approximately only 10% of patients with severe three-vessel CAD or significant left main coronary artery (LMA) stenosis (≥50%) [77,78]
Summary
Despite considerable advances in prevention and management of atherosclerotic heart disease and its devastating consequences, the morbidity and mortality of coronary artery disease (CAD) [1]. This review presents an overview of the place of cardiac positron emission tomography (PET) in the diagnosis and management of CAD. Since the first PET scanners were introduced into a daily routine more than thirty years ago [3], they have been used for the non-invasive assessment of various cardiac conditions [4]. PET allows functional imaging of the heart, as opposed to anatomical imaging by other non-invasive cardiovascular imaging methods like cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) [5]. There are several factors limiting the integration of cardiac PET into clinical routine (difficult production of positron-emitting radioligands of short physical half-life (Table 1), generation of perfusion tracers which need an on-site cyclotron facility and the high PET imaging costs) [4].
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