Abstract
Hybrid imaging of positron emission tomography (PET) together with computed tomography (CT) is rapidly emerging. In cardiology, this new advanced hybrid imaging modality allows quantification of cardiac perfusion in combination with assessment of coronary anatomy within a single scanning session of less than 45 minutes. The near-simultaneous anatomical evaluation of coronary arteries using CT and corresponding functional status using PET provides a wealth of complementary information in patients who are being evaluated for (suspected) coronary artery disease, and could help guide clinical patient management in a novel manner. Clinical experience gained with this recently introduced advanced hybrid imaging tool, however, is still limited and its implementation into daily clinical practice remains largely unchartered territory. This review discusses principles of perfusion PET, its diagnostic accuracy, and potential clinical applications of cardiac PET-CT in patients with ischaemic heart disease. (Neth Heart J 2010;18:90–8.)
Similar content being viewed by others
References
Knaapen P, Lubberink M. Cardiac positron emission tomography: myocardial perfusion and metabolism in clinical practice. Clin Res Cardiol. 2008;97:791–6.
Kaufmann PA, Camici PG. Myocardial blood flow measurement by PET: technical aspects and clinical applications. J Nucl Med. 2005;46:75–88.
Di Carli MF, Hachamovitch R. New technology for noninvasive evaluation of coronary artery disease. Circulation. 2007;115:1464–80.
Le Guludec D, Lautamaki R, Knuuti J, Bax JJ, Bengel FM. Present and future of clinical cardiovascular PET imaging in Europe a position statement by the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging. 2008;35:1709–24.
Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, de Feyter P, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J. 2008;29:531–56.
Camici PG. Positron emission tomography and myocardial imaging. Heart. 2000;83:475–80.
Iida H, Kanno I, Takahashi A, Miura S, Murakami M, Takahashi K, et al. Measurement of absolute myocardial blood flow with H215O and dynamic positron-emission tomography. Strategy for quantification in relation to the partial-volume effect. Circulation. 1988;78:104–15.
Knaapen P, Boellaard R, Gotte MJ, van der Weerdt AP, Visser CA, Lammertsma AA, et al. The perfusable tissue index: a marker of myocardial viability. J Nucl Cardiol. 2003;10:684–91.
Boellaard R, Knaapen P, Rijbroek A, Luurtsema GJ, Lammertsma AA. Evaluation of basis function and linear least squares methods for generating parametric blood flow images using 15O-water and Positron Emission Tomography. Mol Imaging Biol. 2005;7:273–85.
Machac J. Cardiac positron emission tomography imaging. Semin Nucl Med. 2005;35:17–36.
Bateman TM, Heller GV, McGhie AI, Friedman JD, Case JA, Bryngelson JR, et al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: comparison with ECGgated Tc-99m sestamibi SPECT. J Nucl Cardiol. 2006;13:24–33.
Yoshinaga K, Katoh C, Noriyasu K, Iwado Y, Furuyama H, Ito Y, et al. Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15-labeled water PET. J Nucl Cardiol. 2003;10:275–83.
Parkash R, deKemp RA, Ruddy TD, Kitsikis A, Hart R, Beauchesne L, et al. Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease. J Nucl Cardiol. 2004;11:440–9.
Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;17;97:535–43.
Marwick TH, Shan K, Patel S, Go RT, Lauer MS. Incremental value of rubidium-82 positron emission tomography for prognostic assessment of known or suspected coronary artery disease. Am J Cardiol. 1997;80:865–70.
Yoshinaga K, Chow BJ, Williams K, Chen L, deKemp RA, Garrard L, et al. What is the prognostic value of myocardial perfusion imaging using rubidium-82 positron emission tomography? J Am Coll Cardiol. 2006;48:1029–39.
Schenker MP, Dorbala S, Hong EC, Rybicki FJ, Hachamovitch R, Kwong RY, et al. Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study. Circulation. 2008;117:1693–700.
Tio RA, Dabeshlim A, Siebelink HM, de Sutter J, Hillege HL, Zeebregts CJ, et al. Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease. J Nucl Med. 2009;50:214–9.
Stanford W, Thompson BH, Burns TL, Heery SD, Burr MC. Coronary artery calcium quantification at multi-detector row helical CT versus electron-beam CT. Radiology. 2004;230:397–402.
Nallamothu BK, Saint S, Bielak LF, Sonnad SS, Peyser PA, Rubenfire M, et al. Electron-beam computed tomography in the diagnosis of coronary artery disease: a meta-analysis. Arch Intern Med. 2001;161:833–8.
Brown BG, Morse J, Zhao XQ, Cheung M, Marino E, Albers JJ. Electron-beam tomography coronary calcium scores are superior to Framingham risk variables for predicting the measured proximal stenosis burden. Am J Cardiol. 2001;88:23E–26E.
Lamont DH, Budoff MJ, Shavelle DM, Shavelle R, Brundage BH, Hagar JM. Coronary calcium scanning adds incremental value to patients with positive stress tests. Am Heart J. 2002;143:861–7.
O’Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, et al. American College of Cardiology/American Heart Association Expert Consensus Document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol. 2000;36:326–40.
Cheng VY, Lepor NE, Madyoon H, Eshaghian S, Naraghi AL, Shah PK. Presence and severity of noncalcified coronary plaque on 64-slice computed tomographic coronary angiography in patients with zero and low coronary artery calcium. Am J Cardiol. 2007;99:1183–6.
Pundziute G, Schuijf JD, Jukema JW, Boersma E, Scholte AJ, Kroft LJ, et al. Noninvasive assessment of plaque characteristics with multislice computed tomography coronary angiography in symptomatic diabetic patients. Diabetes Care. 2007;30:1113–9.
Pundziute G, Schuijf JD, Jukema JW, Boersma E, de Roos A, van der Wall EE, et al. Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2007;49:62–70.
Abdulla J, Abildstrom SZ, Gotzsche O, Christensen E, Kober L, Torp-Pedersen C. 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and metaanalysis. Eur Heart J. 2007;28:3042–50.
Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52:1724–32.
Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008;52:2135–44.
Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol. 2005;46:147–54.
Hacker M, Jakobs T, Matthiesen F, Vollmar C, Nikolaou K, Becker C, et al. Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: first clinical experiences. J Nucl Med. 2005;46:1294–300.
Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, Lamb HJ, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol. 2006;48:2508–14.
Rispler S, Keidar Z, Ghersin E, Roguin A, Soil A, Dragu R, et al. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol. 2007;49:1059–67.
Di Carli MF, Dorbala S, Curillova Z, Kwong RJ, Goldhaber SZ, Rybicki FJ, et al. Relationship between CT coronary angiography and stress perfusion imaging in patients with suspected ischemic heart disease assessed by integrated PET-CT imaging. J Nucl Cardiol. 2007;14:799–809.
van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol. 2009;53:623–32.
Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med. 2007;356:830–40.
Di Carli MF, Dorbala S, Meserve J, El Fakhri G, Sitek A, Moore SC. Clinical myocardial perfusion PET/CT. J Nucl Med. 2007;48:783–93.
Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005l;32:855–97.
Herzog BA, Husmann L, Landmesser U, Kaufmann PA. Lowdose computed tomography coronary angiography and myocardial perfusion imaging: cardiac hybrid imaging below 3mSv. Eur Heart J. 2009;30:644.
Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M, Martinoff S, et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation. 2006;113:1305–10.
Jakobs TF, Becker CR, Ohnesorge B, Flohr T, Suess C, Schoepf UJ, et al. Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur Radiol. 2002;12:1081–6.
Knuuti J. Cardiac hybrid imaging with low radiation dose. J Nucl Cardiol. 2008;15:743–4.
Husmann L, Valenta I, Gaemperli O, Adda O, Treyer V, Wyss CA, et al. Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J. 2008;29:191–7.
Kajander S, Ukkonen H, Sipila H, Teras M, Knuuti J. Low radiation dose imaging of myocardial perfusion and coronary angiography with a hybrid PET/CT scanner. Clin Physiol Funct Imaging. 2009;29:81–8.
Chareonthaitawee P, Kaufmann PA, Rimoldi O, Camici PG. Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans. Cardiovasc Res. 2001;50:151–61.
Author information
Authors and Affiliations
Corresponding author
Additional information
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands
Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
Rights and permissions
About this article
Cite this article
Knaapen, P., de Haan, S., Hoekstra, O.S. et al. Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease. NHJL 18, 90–98 (2010). https://doi.org/10.1007/BF03091744
Issue Date:
DOI: https://doi.org/10.1007/BF03091744