What is the role of PET scanning in cardiac assessment?

Updated: Nov 20, 2018
  • Author: Richard S Krause, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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There are two specific clinical applications of positron emission tomography (PET) scanning that have been proposed for the evaluation of patients with known or suspected CAD. Detection of CAD and estimation of severity is performed using a PET perfusion agent at rest and during pharmacologic vasodilation. The second clinical application of PET is the assessment of myocardial viability in patients with CAD and left ventricular dysfunction. The most common approach is to determine whether metabolic activity is preserved in regions with reduced perfusion as a marker of glucose utilization and, thus, tissue viability.

The combined technique of PET/CT scanning of the coronary arteries was shown in one study to compare favorably with the criterion standard of catheter coronary angiography. One hundred seven patients with an intermediate pretest likelihood of CAD underwent PET/CT scanning, and the results were compared with invasive angiography. PET scanning and CTA alone each demonstrated 97% negative predictive value; however CTA alone provided suboptimal assessment of the severity of stenosis (positive predictive value, 81%). Perfusion imaging alone was not always able to distinguish microvascular disease from epicardial stenosis, but hybrid PET/CT scanning significantly improved this accuracy to 98%. [40]

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