This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Bengel, F. M. Articles by Lautamäki, R. Search for Related Content PubMed PubMed Citation Articles by Bengel, F. M. Articles by Lautamäki, R. Related Collections Related Article

STATE-OF-THE-ART PAPER

Cardiac Positron Emission Tomography

Division of Nuclear Medicine/PET, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland

Manuscript received November 13, 2008; revised manuscript received January 27, 2009, accepted February 23, 2009.

^_* Reprint requests and correspondence: Dr. Frank M. Bengel, Director of Cardiovascular Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 North Caroline Street/JHOC 3225, Baltimore, Maryland 21287 (Email: fbengel1{at}jhmi.edu).

Positron emission tomography (PET) is a powerful, quantitative imaging modality that has been used for decades to noninvasively investigate cardiovascular biology and physiology. Due to limited availability, methodologic complexity, and high costs, it has long been seen as a research tool and as a reference method for validation of other diagnostic approaches. This perception, fortunately, has changed significantly within recent years. Increasing diversity of therapeutic options for coronary artery disease, and increasing specificity of novel therapies for certain biologic pathways, has resulted in a clinical need for more accurate and specific diagnostic techniques. At the same time, the number of PET centers continues to grow, stimulated by PET's success in oncology. Methodologic advances as well as improved radiotracer availability have further contributed to more widespread use. Evidence for diagnostic and prognostic usefulness of myocardial perfusion and viability assessment by PET is increasing. Some studies suggest overall cost-effectiveness of the technique despite higher costs of a single study, because unnecessary follow-up procedures can be avoided. The advent of hybrid PET-computed tomography (CT), which enables integration of PET-derived biologic information with multislice CT-derived morphologic information, and the key role of PET in the development and translation of novel molecular-targeted imaging compounds, have further contributed to more widespread acceptance. Today, PET promises to play a leading diagnostic role on the pathway toward a future of high-powered, comprehensive, personalized, cardiovascular medicine. This review summarizes the state-of-the-art in current imaging methodology and clinical application, and outlines novel developments and future directions.

Key Words: positron emission tomography • myocardial perfusion • myocardial viability • hybrid imaging • molecular imaging

Abbreviations and Acronyms   CAD = coronary artery disease   CFR = coronary flow reserve   CMS = Centers for Medicare and Medicaid Services   CT = computed tomography   FDA = Food and Drug Administration   FDG = fluorodeoxyglucose   MBF = myocardial blood flow   PET = positron emission tomography   SPECT = single-photon emission computed tomography

Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 54: A22. [Full Text] [PDF]

This article has been cited by other articles:

				Y. Nakauchi, Y. Iwanaga, S. Ikuta, M. Kudo, K. Kobuke, T. Murakami, and S. Miyazaki Quantitative myocardial perfusion analysis using multi-row detector CT in acute myocardial infarction Heart, January 27, 2012; (2012) heartjnl-2011-300915v1. [Abstract] [Full Text]

				M. Hacker Absolute Quantification of Myocardial Perfusion: A Method Proves Its Mettle Circ Cardiovasc Imaging, November 1, 2011; 4(6): 607 - 609. [Full Text] [PDF]

				M. A. Schroeder, K. Clarke, S. Neubauer, and D. J. Tyler Hyperpolarized Magnetic Resonance: A Novel Technique for the In Vivo Assessment of Cardiovascular Disease Circulation, October 4, 2011; 124(14): 1580 - 1594. [Full Text] [PDF]

				O. Gaemperli, F. M. Bengel, and P. A. Kaufmann Cardiac hybrid imaging Eur. Heart J., September 1, 2011; 32(17): 2100 - 2108. [Abstract] [Full Text] [PDF]

				F. M. Bengel Leaving Relativity Behind: Quantitative Clinical Perfusion Imaging J. Am. Coll. Cardiol., August 9, 2011; 58(7): 749 - 751. [Full Text] [PDF]

				F. M. Bengel Imaging Targets of the Sympathetic Nervous System of the Heart: Translational Considerations J. Nucl. Med., August 1, 2011; 52(8): 1167 - 1170. [Abstract] [Full Text] [PDF]

				T. Higuchi, K. Fukushima, C. Rischpler, T. Isoda, M. S. Javadi, H. Ravert, D. P. Holt, R. F. Dannals, I. Madar, and F. M. Bengel Stable Delineation of the Ischemic Area by the PET Perfusion Tracer 18F-Fluorobenzyl Triphenyl Phosphonium After Transient Coronary Occlusion J. Nucl. Med., June 1, 2011; 52(6): 965 - 969. [Abstract] [Full Text] [PDF]

				K. Fukushima, M. S. Javadi, T. Higuchi, R. Lautamaki, J. Merrill, S. G. Nekolla, and F. M. Bengel Prediction of Short-Term Cardiovascular Events Using Quantification of Global Myocardial Flow Reserve in Patients Referred for Clinical 82Rb PET Perfusion Imaging J. Nucl. Med., May 1, 2011; 52(5): 726 - 732. [Abstract] [Full Text] [PDF]

				N. Ghosh, O. E. Rimoldi, R. S. B. Beanlands, and P. G. Camici Assessment of myocardial ischaemia and viability: role of positron emission tomography Eur. Heart J., December 2, 2010; 31(24): 2984 - 2995. [Abstract] [Full Text] [PDF]

				S. Senthamizhchelvan, P. E. Bravo, C. Esaias, M. A. Lodge, J. Merrill, R. F. Hobbs, G. Sgouros, and F. M. Bengel Human Biodistribution and Radiation Dosimetry of 82Rb J. Nucl. Med., October 1, 2010; 51(10): 1592 - 1599. [Abstract] [Full Text] [PDF]

				T. H. Schindler, H. R. Schelbert, A. Quercioli, and V. Dilsizian Cardiac PET Imaging for the Detection and Monitoring of Coronary Artery Disease and Microvascular Health J. Am. Coll. Cardiol. Img., June 1, 2010; 3(6): 623 - 640. [Abstract] [Full Text] [PDF]

				Y. W. Wu, Y. H. Chen, S. S. Wang, H. Y. Jui, R. F. Yen, K. Y. Tzen, M. F. Chen, and C. M. Lee PET Assessment of Myocardial Perfusion Reserve Inversely Correlates with Intravascular Ultrasound Findings in Angiographically Normal Cardiac Transplant Recipients J. Nucl. Med., June 1, 2010; 51(6): 906 - 912. [Abstract] [Full Text] [PDF]

				P. E. Bravo, D. Chien, M. Javadi, J. Merrill, and F. M. Bengel Reference Ranges for LVEF and LV Volumes from Electrocardiographically Gated 82Rb Cardiac PET/CT Using Commercially Available Software J. Nucl. Med., June 1, 2010; 51(6): 898 - 905. [Abstract] [Full Text] [PDF]

				N. R Van de Veire, R. Djaberi, J. D Schuijf, and J. J Bax Non-invasive assessment of coronary artery disease in diabetes Heart, April 1, 2010; 96(7): 560 - 572. [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, et al. Highlights of the Year in JACC 2009 J. Am. Coll. Cardiol., January 26, 2010; 55(4): 380 - 407. [Full Text] [PDF]