PET scanning in evaluation of ischemic heart disease

The question regarding the use of PET for the diagnosis and evaluation of treatment of patients with known or suspected ischemic heart disease is one of defining the proper test. The data available indicate so long as relatively crude information is required that thallium (or new technetium labeled agents, sestamibi and teboroxime) may provide such information almost as well as PET. Examples include simple yes/no answers to questions such as 1) the presence of relatively advanced coronary disease or 2) amelioration of same with CABG or PTCA or 3) the presence of any viable myocardium bordering an infarct area. It also is clear that once more subtle or more precise information is required regarding response to therapy, functional significance of coronary stenosis, or extent of viable myocardium present that PET technology is superior to that of SPECT and therefore should be employed in the evaluation and treatment of patients with known or suspected ischemic heart disease. Finally, were cost not a consideration, it is clear that PET should be used in all cardiac patients and could supplant all currently available conventional radionuclide techniques.