Positron Emission Tomography in the Routine Management of Coronary Artery Disease

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A New Cardiovascular Subspecialty ServiceÔÇöNon-invasive PET or PET-CT Imaging Integrated with Intense Preventive-reversal Treatment

For the comprehensive non-invasive diagnosis and management of coronary heart disease based on reversal treatment, myocardial PET perfusion imaging provides the following:

  • non-invasive other than an intravenous injection;
  • high diagnostic accuracy that is definitive, comparable with, or better than coronary arteriography as the basis for lifelong reversal treatment;
  • accurate assessment of severity in specific coronary arteries or branches for deciding on invasive procedures;
  • proven accuracy for following progression or regression of CAD as well as or better than coronary arteriography;
  • capacity for identifying early, non-stenotic coronary atherosclerosis or diffuse disease before significant segmental stenoses, ischemia, symptoms, or contractile dysfunction develop; and
  • visualizing and objectively quantifying abnormal endothelial function associated with early or diffuse atherosclerosis.

Therefore, non-invasive diagnostic PET imaging has advanced beyond the accuracy and clinical utility of most visually interpreted diagnostic coronary arteriography as the optimal approach for principally non-invasive management of CAD. PET perfusion images need to be interpreted in the context of the documented role of endothelium and plaque rupture in the patho-physiology and treatment of CAD.

Diagnostic interpretation of PET perfusion images must recognize and be influenced by the newer therapeutic options of treatment to stabilize or partially reverse coronary atherosclerosis based on intense comprehensive risk factor management.

Essential Technical Details for Clinical Cardiac PET

Cold area imaging for perfusion defects using short half-life perfusion radionuclides is substantially more difficult than using longer half-life fluorodeoxyglucose (FDG) or hot-spot imaging for cancer due to greater technical demands for the cardiac applications demonstrated here. In the authorÔÇÖs experience, good cardiac perfusion images require 40 to 50 million total counts or at least 12 to 15 million true coincidence counts for adequate cold area imaging, for quantifying defect severity and for identifying early mild perfusion changes due to preclinical CAD.