Coronary artery disease imaging with total-body PET

Coronary artery positron emission tomography (PET) is a promising imaging tool that provides mechanistic insights into coronary artery disease, as well as clinical risk stratification. However, conventional PET systems remain limited by poor sensitivity and low signal to noise ratios (SNRs), hampering the robust assessment of coronary artery disease. The recent introduction of total-body PET scanners has enabled the simultaneous acquisition of data across multi-organ systems, with major enhancements in sensitivity and resultant effective resolution. These technological advancements facilitate the detection of lesions with lower radiotracer uptake signals and allow the complex systemic processes contributing to coronary artery disease to be unveiled, with important implications for clinical trial design and novel drug development. The aim of this review is to discuss the current literature on coronary artery PET and to explore how total-body PET systems can be employed to expand our current understanding of coronary artery disease.