From the Guidelines
PET scans using Rb-82 PET/CT are the most accurate imaging modality for detecting cardiac ischemia, with a reported sensitivity and specificity of 90% and 88% for the detection of obstructive coronary disease, and should be considered as a first-line imaging test for patients with suspected or known coronary artery disease. When evaluating cardiac ischemia, the goal is to prioritize morbidity, mortality, and quality of life as the outcome. The use of PET scans, particularly Rb-82 PET/CT, has been shown to provide higher accuracy over conventional nuclear techniques, MPI, and viability 1.
Key Benefits of PET Scans
- Higher spatial resolution and better attenuation correction compared to SPECT
- Ability to quantify absolute myocardial blood flow
- Valuable for patients with obesity, large breasts, or previous equivocal SPECT results
- Provides detailed information about areas of reduced blood flow indicating ischemia
- Helps guide treatment decisions for coronary artery disease The procedure involves injecting the radiotracer, then imaging the heart at rest and under pharmacological stress using agents like adenosine, regadenoson, or dobutamine.
Clinical Evidence
- A single-center prospective study of 510 patients with suspected CAD has shown that Rb-82 PET/CT has demonstrated sensitivity and specificity of 90% and 88% for the detection of obstructive coronary disease compared with ICA 1
- A multicenter registry study included 7,061 patients with known or suspected CAD who underwent a clinically indicated rest/stress Rb-82 PET MPI, and found that the extent and severity of ischemia and scarring on Rb-82 PET MPI provided powerful and incremental risk estimates of cardiac death and all-cause death compared with traditional coronary risk factors 1 Overall, the use of PET scans, particularly Rb-82 PET/CT, is supported by high-quality evidence and should be considered as a first-line imaging test for patients with suspected or known coronary artery disease.
From the Research
Pet Scan for Ischemia
- A PET scan is a non-invasive imaging test that can help diagnose ischemia by measuring blood flow to the heart muscle 2.
- The test uses a small amount of radioactive tracer, such as rubidium-82, to produce images of the heart and its blood vessels 3.
- Semi-quantitative assessment of ischemia with rubidium-82 PET myocardial perfusion imaging can be used to diagnose ischemia, with a summed difference score (SDS) ≥ 2 and a summed stress score (SSS) ≥ 4 indicating ischemia 4.
- PET imaging has been shown to have high diagnostic accuracy for detecting myocardial ischemia, with a sensitivity of 87% and a specificity of 84% 5.
- Compared to other imaging modalities, such as SPECT and CCTA, PET has been found to have the highest accuracy for diagnosing myocardial ischemia 5.
- PET and SPECT can provide valuable information on myocardial perfusion, viability, and function in patients with ischemic heart failure, and can help guide therapy 6.
Advantages of Pet Scan for Ischemia
- High diagnostic accuracy for detecting myocardial ischemia 5.
- Ability to quantify myocardial blood flow and assess myocardial viability 2.
- Non-invasive and relatively low-risk procedure 3.
- Can be used to guide therapy and monitor response to treatment 6.