PET Perfusion and Flow Assessment: Tomorrows’ Technology Today
Quantitative myocardial perfusion PET/CT imaging is one of the most accurate tests for diagnosis and risk stratification of patients with suspected or known CAD. The test provides a comprehensive evaluation of patients with ischemic heart disease including quantitative assessments of regional myocar...
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| Published in | Seminars in nuclear medicine Vol. 50; no. 3; pp. 227 - 237 |
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| Main Author | |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.05.2020
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| Abstract | Quantitative myocardial perfusion PET/CT imaging is one of the most accurate tests for diagnosis and risk stratification of patients with suspected or known CAD. The test provides a comprehensive evaluation of patients with ischemic heart disease including quantitative assessments of regional myocardial perfusion, LV volumes and ejection fraction, calcified atherosclerotic burden, and myocardial blood flow and flow reserve (MFR). A normal stress myocardial blood flow and MFR (>2.0) has a very high negative predictive value and reliably excludes high-risk obstructive CAD. A global normal MFR (>2.0) identifies patients at consistently lower clinical risk. Conversely, a severely reduced MFR (<1.5) identifies patients at high clinical risk for adverse events regardless of whether this is due to obstructive CAD, microvascular dysfunction, or a combination of the 2. On the other hand, the delineation of atherosclerotic burden with either a formal quantitative coronary calcium score or by a semiquantitative assessment of the CT transmission scan is very helpful to guide the need for intensive preventive therapies. Recent evidence suggests that patients with angiographically obstructive CAD and a severe reduction in flow reserve (<1.6) may have a prognostic advantage from revascularization. This finding awaits confirmation by randomized clinical trials. |
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| AbstractList | Quantitative myocardial perfusion PET/CT imaging is one of the most accurate tests for diagnosis and risk stratification of patients with suspected or known CAD. The test provides a comprehensive evaluation of patients with ischemic heart disease including quantitative assessments of regional myocardial perfusion, LV volumes and ejection fraction, calcified atherosclerotic burden, and myocardial blood flow and flow reserve (MFR). A normal stress myocardial blood flow and MFR (>2.0) has a very high negative predictive value and reliably excludes high-risk obstructive CAD. A global normal MFR (>2.0) identifies patients at consistently lower clinical risk. Conversely, a severely reduced MFR (<1.5) identifies patients at high clinical risk for adverse events regardless of whether this is due to obstructive CAD, microvascular dysfunction, or a combination of the 2. On the other hand, the delineation of atherosclerotic burden with either a formal quantitative coronary calcium score or by a semiquantitative assessment of the CT transmission scan is very helpful to guide the need for intensive preventive therapies. Recent evidence suggests that patients with angiographically obstructive CAD and a severe reduction in flow reserve (<1.6) may have a prognostic advantage from revascularization. This finding awaits confirmation by randomized clinical trials. |
| Author | Di Carli, Marcelo F. |
| Author_xml | – sequence: 1 givenname: Marcelo F. surname: Di Carli fullname: Di Carli, Marcelo F. email: mdicarli@bwh.harvard.edu organization: Cardiovascular Imaging Program, Departments of Medicine and Radiology; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32284109$$D View this record in MEDLINE/PubMed |
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