Module 09. How to Perform an 18F FDG Viability Study-How to Perform an 18 F-FDG Viability Study (Slides)

How to Perform an 18 F-FDG Viability Study (Slides)

Pdf Summary

Module 9 of the "How to Perform Cardiac PET" series focuses on performing an 18F-FDG viability study. The goal of this module is to learn the procedures and techniques for preparing patients, administering the tracer, acquiring and processing images, interpreting the results, and reporting the findings. The viability study is typically performed in patients with ischemic heart failure who have potential coronary artery targets for revascularization and elevated surgical risk. Elderly patients, those with multiple comorbidities, prior CABG, no evidence of ischemia, and persistent perfusion defects suggesting scar or hibernation are also good candidates for this study.<br /><br />18F-FDG is used as a metabolic substrate by chronically ischemic cardiomyocytes, which prefer it over fatty acids. Myocardial uptake of 18F-FDG can identify viable but chronically ischemic myocardium, and in areas of reduced perfusion, it indicates hibernating myocardium. Various imaging techniques and procedures are discussed, including attenuation correction, PET imaging, quality control, and CT calibration.<br /><br />Special considerations are given to patients with diabetes, who may require higher doses of insulin and closer monitoring to optimize myocardial glucose uptake. The module also covers the use of other PET and SPECT tracers for perfusion imaging.<br /><br />The interpretation of perfusion and 18F-FDG images is important for identifying viable myocardium. Different patterns can be observed, including normal blood flow and 18F-FDG uptake, reduced blood flow with preserved or enhanced 18F-FDG uptake, perfusion-metabolism mismatch, and perfusion-metabolism match. Only the last pattern represents nonviable (scarred) tissue.<br /><br />The module includes recommendations for reporting the findings of the viability study. Information on demographics, study indications, technique, findings, gated MPI, and conclusions should be included in the report. The report should also provide an estimate of the likelihood of recovery of function and/or outcome benefit based on the study findings.<br /><br />Overall, this module provides a comprehensive guide on how to perform an 18F-FDG viability study and accurately interpret and report the results.

Keywords

Cardiac PET

18F-FDG viability study

Ischemic heart failure

Revascularization

Surgical risk

Elderly patients

Multiple comorbidities

Prior CABG

Myocardial glucose uptake

Perfusion imaging