title: Quantitative PET/CT measures of myocardial flow reserve and atherosclerosis for cardiac risk assessment and predicting adverse patient outcomes.
abstract: Conventional scintigraphic myocardial perfusion imaging with SPECT/CT or with PET/CT has evolved as an important clinical tool for the diagnostic assessment of flow-limiting epicardial lesions and risk stratification of patients with suspected CAD. By determining the relative distribution of radiotracer-uptake in the left-ventricular (LV) myocardium during stress, the presence of flow-limiting CAD lesions can be identified. While this approach successfully identifies epicardial coronary artery lesions, the presence of subclinical and non-obstructive CAD may go undetected. In this direction, the concurrent ability of PET/CT to assess absolute myocardial blood flow (MBF) in ml/g/min, rather that relative regional distribution of radiotracer-uptake, and myocardial flow reserve (MFR), expands the scope of conventional myocardial perfusion imaging from the identification of more advanced and flow-limiting epicardial lesions to (1) subclinical CAD, (2) an improved characterization of the extent and severity of CAD burden, and (3) the discovery of "balanced" reduction in myocardial blood flow as a consequence of 3 vessel CAD. Concurrent to the PET data, the CT component of the hybrid PET/CT allows the assessment of coronary artery calcification as an indirect surrogate for CAD burden, without contrast, or with contrast angiography to directly denote coronary stenosis and/or plaque morphology with CT. Hybrid PET/CT system, therefore, has the potential to not only identify and characterize flow-limiting epicardial lesions but also subclinical stages of functional and/or structural stages of CAD. Whether the application of PET/CT for an optimal assessment of coronary pathology, its downstream effects on myocardial perfusion, and coronary circulatory function will in effect lead to changes in clinical decision-making process, investiture in preventive health care, and improved long-term outcome, awaits scientific verification.
authors: Department of Specialties in Medicine, Division of Cardiology, Nuclear Cardiology and Cardiac PET/CT, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4,Geneva, Switzerland. ines_valenta@hotmail.com
authors: Ines
authors: I
authors: Valenta
authors: Vasken
authors: V
authors: Dilsizian
authors: Alessandra
authors: A
authors: Quercioli
authors: Terrence D
authors: TD
authors: Ruddy
authors: Thomas H
authors: TH
authors: Schindler
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003326:Coronary Circulation / Q000502:physiology; D006801:Humans; D064847:Multimodal Imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods; D049268:Positron-Emission Tomography; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D014057:Tomography, X-Ray Computed
references: J Am Coll Cardiol. 2009 Jul 7;54(2):150-6
references: 19573732
references: JACC Cardiovasc Imaging. 2009 Jun;2(6):774-86
references: 19520351
references: J Am Coll Cardiol. 2009 Jun 30;54(1):1-15
references: 19555834
references: JACC Cardiovasc Imaging. 2010 Jun;3(6):623-40
references: 20541718
references: J Nucl Med. 2004 Mar;45(3):419-28
references: 15001682
references: J Nucl Cardiol. 2006 Nov;13(6):e121-51
references: 17174789
references: Circulation. 1975 Jun;51(6):1085-94
references: 1132098
references: Circulation. 1995 Apr 15;91(8):2174-83
references: 7697846
references: Nature. 1999 Jun 10;399(6736):601-5
references: 10376603
references: Circ Res. 1985 Sep;57(3):341-53
references: 3896552
references: JACC Cardiovasc Imaging. 2009 Jun;2(6):751-8
references: 19520347
references: Am Heart J. 1994 Jul;128(1):178-81
references: 8017272
references: Eur Heart J. 2012 Apr;33(8):1007-16
references: 22285583
references: Circulation. 1999 Feb 2;99(4):491-7
references: 9927394
references: J Nucl Cardiol. 2010 Dec;17(6):1023-33
references: 20658271
references: J Am Coll Cardiol. 1994 Mar 15;23(4):833-43
references: 8106687
references: Circulation. 1996 Aug 1;94(3):258-65
references: 8759064
references: Arterioscler Thromb Vasc Biol. 2005 Aug;25(8):1551-7
references: 15879305
references: J Am Coll Cardiol. 1994 Oct;24(4):940-7
references: 7930228
references: J Nucl Cardiol. 2007 Jul;14(4):589-603
references: 17679069
references: N Engl J Med. 1984 Mar 29;310(13):819-24
references: 6700670
references: J Nucl Med. 1988 Jul;29(7):1181-8
references: 3260624
references: J Am Coll Cardiol. 2006 Mar 21;47(6):1188-95
references: 16545651
references: Eur Heart J. 2011 Nov;32(22):2824-9
references: 21804107
references: J Nucl Med. 2007 Mar;48(3):349-58
references: 17332611
references: J Nucl Cardiol. 1997 Nov-Dec;4(6):451-63
references: 9456184
references: Circulation. 1995 Apr 1;91(7):1944-51
references: 7895351
references: J Am Coll Cardiol. 1988 Sep;12(3):692-3
references: 3403827
references: Circulation. 2005 Jan 25;111(3):363-8
references: 15668353
references: Eur Heart J. 2007 Feb;28(3):278-91
references: 17218452
references: Am J Cardiol. 1978 Nov;42(5):761-8
references: 707289
references: J Am Coll Cardiol. 2003 Apr 16;41(8):1387-93
references: 12706936
references: Am J Cardiol. 1996 May 1;77(11):948-54
references: 8644644
references: N Engl J Med. 1994 Jun 23;330(25):1782-8
references: 8190154
references: J Nucl Cardiol. 2012 Aug;19(4):670-80
references: 22415819
references: Circulation. 2001 Nov 6;104(19):2305-10
references: 11696470
references: JACC Cardiovasc Imaging. 2009 Aug;2(8):1009-23
references: 19679290
references: Eur Heart J. 2010 Apr;31(8):936-42
references: 19897496
references: Eur J Nucl Med Mol Imaging. 2008 Sep;35(9):1593-601
references: 18425513
references: Circulation. 2000 Mar 21;101(11):1344-51
references: 10725297
references: J Am Coll Cardiol. 2002 Sep 18;40(6):1051-58
references: 12354427
references: Eur J Nucl Med Mol Imaging. 2012 Mar;39(3):430-6
references: 22143224
references: J Am Coll Cardiol. 2005 Jul 5;46(1):147-54
references: 15992649
references: J Nucl Med. 2008 Apr;49(4):564-72
references: 18344444
references: J Am Coll Cardiol. 1988 Apr;11(4):882-5
references: 3280642
references: Circulation. 1995 Jul 15;92(2):197-204
references: 7600651
references: J Nucl Cardiol. 2006 Jan-Feb;13(1):24-33
references: 16464714
references: J Nucl Med. 2011 May;52(5):726-32
references: 21498538
references: J Am Coll Cardiol. 2007 Mar 13;49(10):1052-8
references: 17349884
references: J Am Coll Cardiol. 2005 May 3;45(9):1505-12
references: 15862426
references: Curr Cardiol Rep. 2012 Apr;14(2):217-25
references: 22205177
references: Circulation. 2008 Mar 11;117(10):1283-91
references: 18268144
references: Circulation. 1994 May;89(5):2150-60
references: 8181140
references: Eur J Nucl Med Mol Imaging. 2012 Aug;39(8):1233-9
references: 22648514
references: JACC Cardiovasc Imaging. 2009 May;2(5):664-9
references: 19442957
references: Circulation. 1991 Feb;83(2):391-401
references: 1991363
references: J Am Coll Cardiol. 1996 Sep;28(3):565-72
references: 8772740
references: J Clin Invest. 1987 May;79(5):1473-8
references: 3494749
references: J Nucl Med. 2009 Feb;50(2):214-9
references: 19164219
references: Circulation. 1999 Jun 8;99(22):2871-5
references: 10359730
references: Circulation. 2005 May 10;111(18):2291-8
references: 15851590
references: Circulation. 1989 Apr;79(4):825-35
references: 2784361
references: Eur J Nucl Med Mol Imaging. 2009 Oct;36(10):1594-602
references: 19408000
references: Circulation. 2012 Oct 9;126(15):1858-68
references: 22919001
references: Eur Heart J. 2011 Jun;32(11):1369-78
references: 21303779
references: J Nucl Cardiol. 2003 May-Jun;10(3):275-83
references: 12794626