Positron emission tomography myocardial perfusion imaging for the detection of atherosclerosis

Abstract

Clinically indicated radionuclide myocardial perfusion imaging most often is performed using single photon emission CT (SPECT). Its major strengths include an extensive knowledge base attesting to its diagnostic accuracy and ability to stratify risk of short-term events, and the wide availability of instrumentation. However, it is not accurate for detecting subclinical coronary artery disease (CAD), it can seriously underestimate CAD extent, and it performs better in patients who are able to exercise. Myocardial perfusion positron emission tomography (PET) is an option that is being increasingly used for more challenging patients, especially those who need to be stressed pharmacologically. The current evidence base is small, with most work concentrated on exploring how PET data may expand the field of nuclear cardiology, rather than comparing it with SPECT. A few capabilities unique to PET include potential of routine quantitation of myocardial blood flow, assessment of peak stress rather than post-stress left ventricular function, and superior compensation for scattered counts.