18-Fluorodeoxyglucose imaging with positron emission tomography and single photon emission computed tomography: Cardiac applications

The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with extensive viable myocardium, patients with predominantly scar tissue should be treate...

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Published in:	Seminars in nuclear medicine Vol. 30; no. 4; pp. 281 - 298
Main Authors:	Bax, Jeroen J., Patton, James A., Pldermans, Don, Elhendy, Abdou, Sandler, Martin P.
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-10-2000 Elsevier
Subjects:	Biological and medical sciences Cardiology. Vascular system Cardiovascular system Coronary Disease - diagnostic imaging Coronary Disease - metabolism Coronary Disease - therapy Coronary heart disease Fluorodeoxyglucose F18 - pharmacokinetics Heart Heart - diagnostic imaging Heart Diseases - diagnostic imaging Heart Diseases - metabolism Heart Diseases - therapy Humans Investigative techniques, diagnostic techniques (general aspects) Medical sciences Myocardial Revascularization Myocardium - metabolism Prognosis Radionuclide investigations Radiopharmaceuticals - pharmacokinetics Tomography, Emission-Computed Tomography, Emission-Computed, Single-Photon Ventricular Function, Left Radionuclide study Human Evaluation Prognosis Angioplasty Indication Cardiovascular disease Transplantation Review Glucose Metabolism Coronary heart disease Photon Decision aid Myocardium Left ventricle performance Viability Positron Emission tomography
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Summary:	The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with extensive viable myocardium, patients with predominantly scar tissue should be treated medically or evaluated for heart transplantation. Among the many viability tests, noninvasive assessment of cardiac glucose use (as a marker of viable tissue) with F18-fluorodeoxyglucose (FDG) is considered the most accurate technique to detect viable myocardium. Cardiac FDG uptake has traditionally been imaged with positron emission tomography (PET). Clinical studies have shown that FDG-PET can accurately identify patients with viable myocardium that are likely to benefit from revascularization procedures, in terms of improvement of left ventricular (LV) function, alleviation of heart failure symptoms, and improvement of long-term prognosis. However, the restricted availability of PET equipment cannot meet the increasing demand for viability studies. As a consequence, much effort has been invested over the past years in the development of 511-keV collimators, enabling FDG imaging with single-photon emission computed tomography (SPECT). Because SPECT cameras are widely available, this approach may allow a more widespread use of FDG for the assessment of myocardial viability. Initial studies have directly compared FDG-SPECT with FDG-PET and consistently reported a good agreement for the assessment of myocardial viability between these 2 techniques. Additional studies have shown that FDG-SPECT can also predict improvement of LV function and heart failure symptoms after revascularization. Finally, recent developments, including coincidence imaging and attenuation correction, may further optimize cardiac FDG imaging (for the assessment of viability) without PET systems.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0001-2998 1558-4623
DOI:	10.1053/snuc.2000.9543