Evaluation of coronary artery disease with positron emission tomography

Positron emission tomography (PET) represents the most sophisticated imaging modality in nuclear medicine allowing quantification of regional tracer tissue concentrations. Beside the technical superiority of data acquisition, a large number of PET radiopharmaceuticals are available for clinical application. Based on currently available data, PET provides detection of coronary artery disease with higher diagnostic accuracy than conventional thallium-201 single positron emission computed tomography. Applications of PET with metabolic tracers have been shown to provide clinically important information in the management of patients with advanced coronary artery disease. Metabolic tissue characterization represents the most specific definition of tissue viability currently available. However, the relatively high cost of the technology and the lack of reimbursement by major insurance carriers has limited widespread clinical application. In addition to the acceptance of PET as an advanced clinical imaging modality, this imaging modality excels as a sophisticated research tool assessing specific tissue functions that could not be visualized before in the living human heart. Without doubt, this technique will contribute significantly to the future characterization of pathophysiological alterations in substrate metabolism and other physiological processes such as autonomic innervation. Furthermore, the kinetics of radiolabeled cardiac drugs may be studied with PET to provide objective characterization of cardiovascular drug effects and thus enhance our understanding of pharmacokinetics in the human heart.