Diagnosing Non-Ischemic Cardiomyopathies on Myocardial Perfusion Imaging with Positron Emission Tomography

This article summarizes findings seen in various cardiomyopathies on myocardial perfusion imaging (MPI) with positron emission tomography (PET).

MPI is the cornerstone for evaluation of coronary ischemia, and technological advancements have yielded improved imaging quality and reduction in radiation exposure, particularly with PET. Multi-specialty guidelines and appropriate use criteria provide guidance on utilization of PET MPI in various scenarios related to evaluation of chest pain, new onset cardiomyopathy, and other scenarios where coronary ischemia should be assessed. Various non-ischemic cardiomyopathies such as septal and apical hypertrophic cardiomyopathy, amyloidosis, sarcoidosis, takotsubo, and dilated cardiomyopathy have typical imaging findings on PET MPI and can be identified if these patterns are understood. It is essential to recognize specific imaging patterns in non-ischemic cardiomyopathies which may aide in diagnosis. Ultimately, multimodality imaging, including echocardiography and cardiac magnetic resonance, complement PET MPI in diagnosing and guiding treatment options for these conditions.