Cardiac PET-CT and its Implementation into Clinical Practice

Positron emission tomography (PET) is the most advanced scintigraphic imaging technique used for in vivo assessment of cardiac pathophysiology. Very recently, 16- and 64-slice hybrid PET- computed tomography (CT) scanners have been introduced into clinical routine allowing the comprehensive work up of patients with coronary artery disease (CAD). The integration of radionuclide imaging of myocardial perfusion with multidetector CT scanners (i.e. PET-CT) provides the opportunity to detect cardiac and vascular anatomic abnormalities, and their potential clinical consequences, within a single session. Hybrid imaging offers a unique strategy to assess the cardiovascular risk of patients with known or suspected CAD. This includes the detection and quantification of the extent of calcified and non-calcified plaques via coronary artery calcium and coronary angiography, and extends to the quantification of vascular reactivity and endothelial health, the identification of haemodynamically relevant coronary stenoses with the extent of myocardial area at risk, and in the end the assessment of myocardial viability. Dedicated PET-CT protocols have been developed to answer many complex clinical questions. Taken together cardiac hybrid imaging can provide all information to increase the accuracy of noninvasive diagnosis of CAD, to assess cardiac risk, to monitor its course and to improve the clinical decision-making in the management of cardiac patients.