Module 11. Cardiac PET Myocardial Perfusion Imaging Including Myocardial Blood Flow Assessment in Clinical Studies-Cardiac PET Myocardial Perfusion Imaging Including Myocardial Blood Flow (Slides)

Cardiac PET Myocardial Perfusion Imaging Including Myocardial Blood Flow (Slides)

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Cardiac PET myocardial perfusion imaging (MPI) including myocardial blood flow (MBF) assessment is an important tool for diagnosing and managing cardiovascular disease. PET imaging offers advantages such as higher resolution, improved image quality, low radiation exposure, and superior diagnostic accuracy compared to SPECT imaging. PET MPI can be used to evaluate the extent and severity of reversible and fixed perfusion defects, assess myocardial blood flow, and reduce radiation exposure.<br /><br />PET MPI techniques include continuous stationary detectors and simultaneous detection of coincidence photon events, while SPECT imaging involves step and shoot with rotating detector heads. The radiotracers used in PET MPI have short half-lives, resulting in low radiation doses. Different radiotracers have varying levels of first-pass extraction, which affects resolution and detection of milder perfusion defects.<br /><br />PET MPI has superior diagnostic accuracy compared to SPECT, as demonstrated in various studies. It provides higher spatial resolution, improved contrast resolution, higher count density, and attenuation and scatter correction. PET MPI can help determine the presence of ischemia and scar tissue, evaluate left ventricular ejection fraction (LVEF), and identify stress-induced cavity dilation. It is also useful for assessing microvascular dysfunction, multi-vessel disease, and the significance of known obstructive coronary artery disease.<br /><br />Myocardial blood flow quantification with PET is the most accurate non-invasive method to assess MBF and MBF reserve (MBFR). It involves measuring the arterial tracer input function and changes in myocardial tracer uptake. Quantifying MBF and MBFR can aid in diagnosing microvascular dysfunction, diffuse atherosclerosis, and single-vessel epicardial disease.<br /><br />PET MPI has prognostic value for predicting cardiac events and can guide treatment decisions. Studies have shown that adding PET MPI data to clinical risk factors improves risk stratification and prediction of cardiac death. Reduced MBFR is associated with an increased risk of death, and revascularization can provide benefits in patients with reduced MBFR and worsening ischemia or perfusion defects.<br /><br />In summary, cardiac PET MPI, including MBF assessment, offers several advantages over SPECT imaging. It provides superior diagnostic accuracy, quantification of MBF, and prognostic value. PET MPI aids in diagnosis, risk stratification, and selection of patients for revascularization.

Keywords

Cardiac PET

myocardial perfusion imaging

MPI

myocardial blood flow

MBF assessment

cardiovascular disease

PET imaging

SPECT imaging

reversible perfusion defects

fixed perfusion defects