Appropriate Use Criteria for PET Myocardial Perfusion Imaging
Thomas H. Schindler, Timothy M. Bateman, Daniel S. Berman, Panithaya Chareonthaitawee, Lorraine E. De Blanche, Vasken Dilsizian, Sharmila Dorbala, Robert J. Gropler, Leslee J. Shaw, Prem Soman, David E. Winchester, Hein J. Verberne, Sukhjeet Ahuja, Rob Beanlands, Marcelo F. Di Carli, Venkatesh L. Murthy, Terrence D. Ruddy, Ronald G. Schwartz
Abstract
In the last decade, myocardial perfusion imaging (MPI) with PET has emerged to play a pivotal role in the clinical routine process for the detection of hemodynamically significant obstructive coronary artery disease (CAD) and cardiovascular risk stratification (1-5). The high spatial and contrast resolution in concert with photon attenuation-free images of PET have led to high image quality associated with the highest sensitivity and specificity of PET/CT perfusion imaging in the detection and characterization of CAD (1,2,6,7). In addition, the noninvasive evaluation and quantification of global and regional myocardial blood flow (MBF) in milliliters per gram per minute during hyperemic stress and at rest, as well as the calculation of the resulting myocardial flow reserve (MFR), extends the scope of standard MPI from the detection of advanced and flow-limiting epicardial CAD to a comprehensive assessment of ischemic burden. This improved scope results not only from the traditionally sought significant left main or multivessel disease, but also from the more recently appreciated cardiac effects of nonobstructive CAD and coronary microvascular disease (CMD), which conveys important diagnostic and incremental prognostic information