title: Myocardial blood flow: Putting it into clinical perspective.
abstract: In recent years, positron emission tomography/computed tomography (PET/CT)-determined myocardial perfusion in conjunction with myocardial blood flow (MBF) quantification in mL·g(-1)·min(-1) has emerged from mere research application to initial clinical use in the detection and characterization of the coronary artery disease (CAD) process. The concurrent evaluation of MBF during vasomotor stress and at rest with the resulting myocardial flow reserve (MFR = MBF during stress/MBF at rest) expands the scope of conventional myocardial perfusion imaging not only to the detection of the most advanced and culprit CAD, as evidenced by the stress-related regional myocardial perfusion defect, but also to the less severe or intermediate stenosis in patients with multivessel CAD. Due to the non-specific nature of the hyperemic MBF and MFR, the interpretation of hyperemic flow increases with PET/CT necessitates an appropriate placement in the context with microvascular function, wall motion analysis, and eventually underlying coronary morphology in CAD patients. This review aims to provide a comprehensive overview of various diagnostic scenarios of PET/CT-determined myocardial perfusion and flow quantification in the detection and characterization of clinically manifest CAD.
authors.affiliation: Division of Nuclear Medicine, Cardiovascular Nuclear Medicine, Department of Radiology and Radiological Science SOM, Johns Hopkins University School of Medicine, JHOC 3225, 601 N. Caroline Street, Baltimore, MD, 21287, USA. tschind3@jhmi.edu.
authors.forename: Thomas Hellmut
authors.initials: TH
authors.lastname: Schindler
mesh_terms: D001783:Blood Flow Velocity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003326:Coronary Circulation; D019317:Evidence-Based Medicine; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: CAD; left ventricular wall motion; multivessel disease; myocardial blood flow; myocardial flow reserve; myocardial ischemia; positron emission tomography