PET myocardial perfusion imaging: Progress in quantitative assessment of blood flow and flow reserve

Abstract

This chapter reviews the role of positron emission tomography (PET) myocardial perfusion imaging for: the identification and characterization of flow-limiting epicardial as well as subclinical coronary artery disease and the evaluation of the responses of myocardial blood flow (MBF) to physiological and pharmacological stimuli and their relationship to coronary circulatory function and coronary pathophysiology. The imaging also used for the assessment of the incremental value of absolute MBF measurements for the delineation of cardiovascular risk, patient outcome, and monitoring responses to therapeutic intervention. Quantitative assessment of regional MBF and myocardial flow reserve may identify not only flow-limiting isolated epicardial lesions, but also the downstream functional outcome of anatomically mild, sequential coronary artery lesions or continuous tapering of coronary artery vessel due to diffuse atherosclerosis. The higher diagnostic accuracy of PET for detecting flow-limiting coronary artery lesions was reproduced when computed tomography attenuation was applied to acquire a transmission scan for attenuation correction.