Metabolic imaging using F18-fluorodeoxyglucose to assess myocardial viability

Over the past 10 years, F18-fluorodeoxyglucose (FDG) imaging with positron emission tomography (PET) has emerged as an important technique in the delineation of myocardial viability. Using this technique it has become possible to predict recovery of ventricular function after revascularization in patients with chronic coronary artery disease. Data from long-term (although retrospective) follow-up studies have demonstrated that patients with viable myocardium on FDG PET who do not undergo revascularization are prone to cardiac events, including cardiac death and non-fatal infarction. The same studies have pointed out that patients with viable tissue on FDG PET, who do undergo revascularization, improve substantially in symptoms related to congestive heart failure. To allow FDG imaging in centers without PET equipment, recent studies have evaluated the use of FDG imaging with single photon emission computed tomography (SPECT) and 511 keV collimators. Preliminary data using this alternative approach are promising, but need further confirmation. In this review the experience with FDG imaging (using either PET or SPECT) in the assessment of tissue viability in patients with coronary artery disease will be discussed.