[The future of PET in cardiology]

Positron emission tomography (PET) is an intrinsically quantitative method that provides an approach for the clinical cardiologist and cardiovascular researchers to evaluate the heart noninvasively. The ability to label biomolecules with positron-emiting radioisotopes, without disturbing their physiological properties, offers the opportunity to prove and quantify coronary blood flow, myocardial metabolism, and the alterations that occur with disease states. However, the major drawback prohibiting implementation of PET imaging in clinical routine is the limited availability of PET equipment and its greater cost per study. In order to enhance cost savings and resource efficiency in clinical practice, PET studies should be limited to those patients with equivocal studies by other imaging modalities or to define areas of potential viability and improve decisions for recommending coronary bypass grafting or cardiac transplantation. The combined data of multiple investigators suggest that 18-FDG-SPECT imaging may become the protocol of choice for determining myocardial viability because of its increased availability and cost-effectiveness as compared to PET.