Cardiac positron tomography: current status and future directions

Positron emission tomography (PET) performed after the administration of the positron-emitting radionuclides carbon-11 (11C), nitrogen-13(13N), oxygen-15(15O) and fluorine-18(18F) has permitted the improved noninvasive assessment of the regional myocardial metabolism of normal physiologic substrates and intermediates and their cogeners. In experimental animals, the rate of oxidation of 11C-palmitate correlates closely with other indexes of oxygen consumption, and the extraction of 11 C-palmitate (like that of 18F-fatty acids and 18F-fluordeoxyglucose) is markedly diminished in regions of myocardial ischemia. In both experimental animals and in patients, myocardial infarct site and size, determined by positron emission tomography after the intravenous injection of 11C-palmitate, correlate closely with the electrocardiographic infarct locus and enzymatically estimated infarct size as well as with the location and extent of regional left ventricular wall motion abnormalities. PET offers promise for assessment of flow as well despite the complexities involved. PET with 13NH3 appears to provide one useful qualitative index, although this tracer is actively metabolized. Because of the quantitative capabilities of positron emission tomography and the rapid progress which is being made in the development of fast scan, multi-slice, and gated instrumentation, this technique is likely to facilitate improved understanding and characterization of regional myocardial metabolism and blood flow in man under physiological and pathophysiological conditions.