The role of PET quantification in cardiovascular imaging

Piotr Slomka, Daniel S. Berman, Erick Alexanderson, Guido Germano
2014 Clinical and translational imaging  
Positron emission tomography (PET) has several clinical applications in cardiovascular imaging. Myocardial perfusion imaging with PET allows accurate global and regional measurements of myocardial perfusion, myocardial blood flow and function at stress and rest in a single examination. Simultaneous assessment of function and perfusion by PET with quantitative software is currently routine practice. Combination of ejection fraction reserve with perfusion information may improve the
more » ... of severe coronary artery disease. Myocardial viability can be estimated by quantitative comparison of fluorine-18 fluorodeoxyglucose ( 18 F-FDG) and rest perfusion imaging. Quantitative myocardial blood flow and myocardial flow reserve measurements are becoming routinely included in clinical assessments due to the enhanced dynamic imaging capabilities of the latest PET/CT scanners. Absolute flow measurements allow evaluation of coronary microvascular dysfunction and provide additional prognostic and diagnostic information in coronary disease. Quantitative clinical software tools for computing myocardial blood flow from kinetic PET data in an automated and rapid fashion have been developed for use with several radiotracers: 13 N-ammonia, 15 O-water and 82 Rb. The level of agreement between various software methods available for such analyses is excellent. Relative quantification of 82 Rb PET myocardial perfusion tracer uptake, based on comparisons with normal perfusion databases, demonstrates high performance for the detection of obstructive coronary disease. Computerized analysis of myocardial perfusion at stress and rest reduces the variability of the assessment compared with visual analysis. New tracers, such as 18 F-flurpiridaz may allow further improvements in myocardial blood flow quantification and disease detection. PET quantification can be enhanced by precise coregistration with CT angiography. In emerging clinical applications, the potential to identify vulnerable plaques by quantification of atherosclerotic plaque uptake of 18 FDG and 18 F-sodium fluoride tracers in carotids, aorta and coronary arteries has been demonstrated.
doi:10.1007/s40336-014-0070-2 pmid:26247005 pmcid:PMC4523308 fatcat:ie7vpe4oljbnlcpqc77tobqvoy