Acquisition, Processing, and Interpretation of PET ¹⁸F-FDG Viability and Inflammation Studies

This article reviews the acquisition protocols and image interpretation for ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) imaging with positron emission tomography (PET) applied to the evaluation of myocardial viability and inflammation.

Cardiac PET with ¹⁸F-FDG provides essential information for the assessment of myocardial viability and inflammation and is usually combined with PET perfusion imaging using ⁸²Rb or ¹³N-ammonia. Viable myocardium maintains glucose metabolism which can be detected via the uptake of ¹⁸F-FDG by PET imaging. The patient is prepared for viability imaging by shifting the metabolism of the heart to maximize the uptake of glucose and hence of ¹⁸F-FDG. Comparison of the ¹⁸F-FDG and myocardial perfusion images allows distinction between regions of the myocardium that are hibernating and thus may recover function with intervention, from those that are infarcted. Increased glucose utilization in the inflammatory cells also makes ¹⁸F-FDG a useful imaging technique in conditions such as cardiac sarcoidosis. Here, suppression of normal myocardial uptake is essential for accurate image interpretation. ¹⁸F-FDG PET broadens the scope of information potentially available through a cardiac PET study. With careful patient preparation, it provides valuable insights into myocardial viability and inflammatory processes such as sarcoidosis.