Cardiovascular imaging with total-body PET

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. PET enables non-invasive imaging of cardiovascular biology at the molecular level, providing insights into pathological processes that precede structural changes detectable by conventional imaging. While conventional PET has been used to investigate isolated cardiac pathologies, its short axial field-of-view (SAFOV) limits the exploration of multi-organ axes influencing cardiovascular disease. The advent of total-body PET systems represents a major advancement in molecular imaging, providing enhanced sensitivities with associated reductions in radiotracer dosing and acquisition times. Furthermore, long axial field-of-view (LAFOV) scanners enable simultaneous assessment of disease activity across the whole cardiovascular and multi-organ systems, facilitating the assessment of organ interactions and network analyses. The aim of this review is to explore the current uses of PET in the imaging of cardiovascular disease and to postulate how integration of total-body PET systems may enhance mechanistic understanding of these pathologies and provide new insights into their treatment.