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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Myocardial blood flow: Putting it into clinical perspective
1Division of Nuclear Medicine, Cardiovascular Nuclear Medicine, Department of Radiology and Radiological Science SOM, Johns Hopkins University School of Medicine, JHOC 3225, 601 N. Caroline Street, Baltimore, MD, 21287, USA. tschind3@jhmi.edu.
Summary
Positron emission tomography/computed tomography (PET/CT) now aids in diagnosing coronary artery disease (CAD) by quantifying myocardial blood flow (MBF) and myocardial flow reserve (MFR). This advanced imaging detects various CAD severities, improving patient diagnosis and characterization.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Diagnostic Radiology
Background:
- Myocardial perfusion and blood flow quantification using PET/CT are transitioning from research to clinical practice for coronary artery disease (CAD) detection.
- Conventional imaging often misses less severe or intermediate coronary stenosis, particularly in multivessel disease.
- Advanced PET/CT techniques offer a more comprehensive assessment beyond traditional perfusion defects.
Purpose of the Study:
- To review the diagnostic utility of PET/CT-determined myocardial perfusion and myocardial blood flow (MBF) quantification in coronary artery disease (CAD).
- To highlight how myocardial flow reserve (MFR) assessment expands CAD detection to include intermediate stenosis.
- To provide an overview of PET/CT applications in diagnosing and characterizing clinically manifest CAD.
Main Methods:
- Utilizing positron emission tomography/computed tomography (PET/CT) for myocardial perfusion imaging.
- Quantifying myocardial blood flow (MBF) at rest and during vasomoter stress.
- Calculating myocardial flow reserve (MFR) as the ratio of stress MBF to rest MBF.
Main Results:
- PET/CT-determined MBF and MFR enable detection of both severe and intermediate coronary artery stenosis.
- Concurrent evaluation of MBF during stress and rest improves CAD characterization in multivessel disease.
- PET/CT findings require integration with microvascular function, wall motion, and coronary morphology for accurate interpretation.
Conclusions:
- PET/CT-based myocardial perfusion and MBF quantification are valuable clinical tools for CAD detection and characterization.
- MFR assessment enhances the detection of intermediate coronary artery stenosis missed by conventional methods.
- Comprehensive interpretation of PET/CT data, considering multiple factors, is crucial for optimal CAD management.
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