Why Should We Be Interested in Cardiac PET/CT Imaging?

Abstract

In this issue of RadioGraphics, a symposium consisting of four comprehensive articles prepared by leaders in the field of cardiac positron emission tomography (PET) is presented (1–4). In many ways, 2011 is an appropriate time to focus on this rapidly expanding modality. The medical literature certainly illustrates the growth of scholarly interest in cardiac PET. During the past 5 years, 658 peer-reviewed articles and several dedicated texts on cardiac PET have been published (5). In the previous 5 years, only 184 were found, based on a Google Scholar search. Despite the proliferation of competing technologies, including magnetic resonance (MR) imaging, multidetector computed tomography (CT), and advanced echocardiography, the volume of cardiac PET/CT studies continues to grow exponentially. This interest is partially related to the rapid growth of the use of PET in oncologic diagnosis and posttreatment follow-up examinations (6). In addition, new advances in technology such as the development of increasingly more efficient software and equipment have been introduced. Many of the problems associated with “thoracic drift” and cardiac motion, which leads to image misregistration, have been addressed with image postprocessing corrections and the use of respiratory and electrocardiographic gating (7). Indications for PET/CT have broadened, particularly for the diagnosis of the ischemic myocardium, obstructive coronary artery disease, and large vessel arteritis, in direct competition to using stand-alone CT and MR imaging for these applications. This upward trend in cardiac PET/CT utilization may also be related to a shift in user preference from single photon emission computed tomography (SPECT) to PET for myocardial perfusion imaging because of the recognized clinical advantages of PET and the uncertainty regarding the available supplies of radionuclides used in SPECT studies. In an in-depth article, Di Carli and Murthy (1) from the Brigham and Women’s Hospital, Boston, discuss the advantages of PET imaging, especially in comparison with SPECT imaging, with an emphasis on use of generator-produced rubidium 82, use of optimized protocols, radiation dose reduction, and minimizing image artifacts. Stolzmann and his associates (2) from Massachusetts General Hospital, Boston, compare the value of cardiac PET and CT for characterizing atherosclerotic disease. The authors emphasize the complementary role of CT for exquisite Robert M. Steiner, MD Why Should We Be Interested in Cardiac PET/CT Imaging?1