Role of PET imaging in assessment of myocardial perfusion and viability
Mostafa Samir MokhtarHamed;
Abstract
Positron emission tomography cardiovascular imaging is a powerful clinical and research tool. It allows determination of the extent and severity of CAD, identification of early coronary disease by absolute myocardial flow measurements, detection of viable myocardium, determination of myocardial metabolism, measurement of cardiac function, and potential differentiation of vulnerable plaques from stable plaques.
Perfusion and viability assessments have become an important investigation in the management of patients with LV dysfunction. This can be done by many imaging techniques such asdobutamine stress echocardiography, Cardiac MRI, SPECT-CT imaging, and 18F-FDG PET-CT.
Assessment of myocardial perfusion defects have been firmly established as an important diagnostic and prognostic tool for the evaluation of patients with suspected CAD. Cardiac PET in conjunction with tracer-kinetic modeling for 13Nammonia, 15O-water, or 82Rubidium affords the assessment of regional MBF of the left ventricle in absolute units in ml/g/min, which adds a new dimension to the noninvasive evaluation of the CAD process.
Viability study can be used to decide whether patient should receive surgical or medical treatment based on viability assessment. This also helped in preventing unnecessary economic loss to the patient apart from reducing morbidity. Viability study should be performed in all patients who present with LV dysfunction due to ischemic heart disease.
Viability assessment should be part of selection process in patients with low LVEF for surgical revascularization. Proper selection of patients based on viability assessment helps in reducing pre-operative and post-operative mortality and also improves outcomes.
In general, nuclear imaging techniques especially PET have a high sensitivity and specificity in comparison with other modalities for the detection of perfusion and viability.
Combination of myocardial perfusionand viability PET images and multislice spiral contrast-enhanced CTA is a feasible and interesting approach for noninvasive complementary evaluation of morphologic and functional CAD. Besides being a noninvasive alternative, the PET/CT and PET/MRI techniques add functional information on the pathophysiologic impact of a lesion allowing accurate clinical decision making on the best therapeutic strategy.
Perfusion and viability assessments have become an important investigation in the management of patients with LV dysfunction. This can be done by many imaging techniques such asdobutamine stress echocardiography, Cardiac MRI, SPECT-CT imaging, and 18F-FDG PET-CT.
Assessment of myocardial perfusion defects have been firmly established as an important diagnostic and prognostic tool for the evaluation of patients with suspected CAD. Cardiac PET in conjunction with tracer-kinetic modeling for 13Nammonia, 15O-water, or 82Rubidium affords the assessment of regional MBF of the left ventricle in absolute units in ml/g/min, which adds a new dimension to the noninvasive evaluation of the CAD process.
Viability study can be used to decide whether patient should receive surgical or medical treatment based on viability assessment. This also helped in preventing unnecessary economic loss to the patient apart from reducing morbidity. Viability study should be performed in all patients who present with LV dysfunction due to ischemic heart disease.
Viability assessment should be part of selection process in patients with low LVEF for surgical revascularization. Proper selection of patients based on viability assessment helps in reducing pre-operative and post-operative mortality and also improves outcomes.
In general, nuclear imaging techniques especially PET have a high sensitivity and specificity in comparison with other modalities for the detection of perfusion and viability.
Combination of myocardial perfusionand viability PET images and multislice spiral contrast-enhanced CTA is a feasible and interesting approach for noninvasive complementary evaluation of morphologic and functional CAD. Besides being a noninvasive alternative, the PET/CT and PET/MRI techniques add functional information on the pathophysiologic impact of a lesion allowing accurate clinical decision making on the best therapeutic strategy.
Other data
| Title | Role of PET imaging in assessment of myocardial perfusion and viability | Other Titles | دورالتصوير باستخدام الإصدار البوزيتروني الانبعاثي لتقييم مدي ارتواء و سلامة عضلة القلب | Authors | Mostafa Samir MokhtarHamed | Issue Date | 2016 |
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