Imaging of the heart by MRI and PET

This review article describes the clinical usefulness and future potential of two new methods for the imaging of the heart, which have recently also become available outside research laboratories. These methods are magnetic resonance imaging (MRI) and positron emission tomography (PET). MRI is the most rapidly increasing imaging modality in medicine today. The moving heart forms a challenge to conventionally rather slow MRI-techniques. Techniques based on ECG-gating have been mandatory in making cardiac cine-MRI possible. Even though MRI provides accurate and quantitative information of the heart, conventional methods are time-consuming, confined to special laboratories, and rather expensive. Therefore, the clinical use of cardiac MRI is, in many laboratories, limited to cases in which echocardiography does not provide adequate information (e.g. pulmonary circulation) or when the patient is not willing to have transoesophageal echocardiography for better visibility. MRI is also used instead of or to complement invasive angiography to study large vessels, and it provides excellent information on paracardiac masses. Cardiac MRI is developing rapidly and within the next few years it is likely to have a profound impact on cardiac imaging. This is based on its noninvasive nature and on the comprehensive anatomic (including coronary arteries), functional, flow, perfusion and possibly also metabolic information it has the potential to provide in a manner not comparable to any other imaging method. PET is a nuclear medicine imaging modality that allows quantitative characterization of a variety of physiological and metabolic processes in vivo. Using positron-emitting flow tracers and analogues of metabolic substrates, regional myocardial blood flow, glucose and fatty acid metabolism and oxygen consumption can be studied noninvasively by PET in research as well as in clinical practice. For example, regional myocardial glucose utilization rates can be measured accurately by PET. This allows us to study the effects of nutritional interventions, hormonal and neural effects as well as disease processes on the glucose utilization of the human heart. PET is currently the only technique that permits noninvasive quantification of regional myocardial perfusion in absolute terms. Over the last decade, PET has also emerged as a clinically useful tool to study coronary artery disease and myocardial viability.