Assessment of myocardial blood flow and coronary flow reserve with positron emission tomography in ischemic heart disease: current state and future directions

• Published in: Heart failure reviews Vol. 22; no. 4; pp. 441 - 453
• Main Authors: Al Badarin, Firas, Aljizeeri, Ahmed, Almasoudi, Fatimah, Al-Mallah, Mouaz H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2017; Springer Nature B.V
• Subjects: Ammonia; Blood flow; Blood Flow Velocity; Cardiology; Cardiovascular disease; Clinical aspects; Computer programs; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Fractional Flow Reserve, Myocardial; Heart diseases; Humans; Image Interpretation, Computer-Assisted; Ischemia; Isotopes; Laboratories; Medicine; Medicine & Public Health; Myocardial Perfusion Imaging; Noninvasive evaluation; Perfusion; Positron emission tomography; Prognosis; Software; Tomography; Coronary flow reserve; Myocardial blood flow; Positron emission tomography; Coronary artery disease
• ISSN: 1382-4147; 1573-7322
• DOI: 10.1007/s10741-017-9625-4

Positron emission tomography (PET) is a versatile imaging technology that allows assessment of myocardial perfusion, both at a spatially relative scale and also in absolute terms, thereby enabling noninvasive evaluation of myocardial blood flow (MBF) and coronary flow reserve (CFR). Assessment of MBF using FDA-approved PET isotopes, such as 82 Rb and 13 N-ammonia, has been well validated, and several software packages are currently available, thereby allowing for MBF evaluation to be incorporated into routine workflow in contemporary nuclear laboratories. Incremental diagnostic and prognostic information provided with the knowledge of MBF has the potential for widespread applications. Improving the ability to identify the true burden of obstructive epicardial coronary stenoses and allowing for noninvasive assessment of coronary micro circulatory function can be achieved with MBF assessment. On the other hand, attenuated CFR has been shown to predict adverse cardiovascular prognosis in a variety of clinical settings and patient subgroups. With expanding applications of MBF, this tool promises to provide unique insight into the integrity of the entire coronary vascular bed beyond what is currently available with relative perfusion assessment. This review intends to provide an in-depth discussion of technical and clinical aspects of MBF assessment with PET as it relates to patients with ischemic heart disease.