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Non-Invasive Imaging
Integrated positron emission tomography/computed tomography (PET/CT) in coronary disease
  1. Juhani Knuuti
  1. Correspondence to Dr Juhani Knuuti, Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland; juhani.knuuti{at}tyks.fi

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In recent years the development of non-invasive cardiac imaging has progressed rapidly. Cardiac multidetector computed tomography (CT) is rapidly becoming an integral part of clinical cardiology. On the other hand, the justification for coronary revascularisation must be based on ischaemia, not solely on anatomical narrowing of the coronary lumen.1 While several standard functional imaging techniques such as nuclear perfusion imaging, stress magnetic resonance imaging, and stress echocardiography have been well established for the detection of ischaemia, they do not provide any information about coronary anatomy.

Hybrid scanners combining positron emission tomography (PET) with high resolution multidetector CT are currently the standard for almost all commercially available systems. Hybrid scanners offer the ability to assess the anatomy of the heart and coronary arteries, and the functional evaluation either at stress (for assessment of induced ischaemia) or at rest (for viability), in association with the left ventricular systolic function. Therefore, combining functional information from PET with morphological data from CT is appealing.2

Why use PET in myocardial perfusion imaging?

Since myocardial perfusion imaging using conventional nuclear medicine techniques is well established, what could be the justification to use PET imaging instead? PET imaging offers a unique possibility to measure myocardial perfusion quantitatively in absolute terms.3,4,5,6 This is useful in patients with diffuse coronary artery disease (CAD) or balanced disease where relative assessment of myocardial perfusion cannot uncover a global reduction in perfusion (fig 1). Typically, in relative analysis of perfusion only, the regions supplied with the most severe stenosis are detected. In less severe cases multivessel disease is likely to be underestimated. Quantification of myocardial perfusion using dynamic PET provides a high performance level for the detection and localisation of CAD3 (fig 1). The incremental value of quantitative analysis was also recently studied and it was found that the …

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