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DISCLOSURES - Honorarium Research / Advisor, Expert Services and Conferences in Nuclear Cardiology BMS, CVT, Astellas, Lantheus, PGx Health, International Atomic Energy Agency Royalties Publications in Nuclear Cardiology Springer-Verlag-Nuclear Cardiology and Correlative Imaging: a teaching file, NY, 2004 Lippincott Williams & Wilkins, - Nuclear Medicine teaching File, 2009 João V. Vitola Quanta Diagnostico Nuclear Brazil PET/CT vs SPECT

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Page 1: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

DISCLOSURES -

Honorarium – Research / Advisor, Expert Services and Conferences in Nuclear Cardiology

BMS, CVT, Astellas, Lantheus, PGx Health, International Atomic Energy Agency

Royalties – Publications in Nuclear Cardiology

Springer-Verlag-Nuclear Cardiology and Correlative Imaging: a teaching file, NY, 2004

Lippincott Williams & Wilkins, - Nuclear Medicine teaching File, 2009

João V. Vitola

Quanta Diagnostico Nuclear

Brazil

PET/CT vs SPECT

Page 2: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

65 yo male

Atypical chest pain

No history of CAD/MI

HTN, hypercholesterolemia

Vitola and Delbeke: Nuclear Cardiology and Correlative Imaging, Springer 2004, NY, Chapter 3

Case

Page 3: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and
Page 4: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and
Page 5: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

SAV – EXERCISE

SAV - REST

VLA – EXERCISE

VLA - REST

HLA – EXERCISE

HLA - REST

Page 6: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

1- Does the ECG change represents a silent MI in the

past ?

2- Does he need any additional viability study ?

Page 7: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Myocardial Viability: 99mTc-perfusion agents

• Retention of MIBI and tetrofosmin depends on cell membrane integrity and mitochondrial function.

• 99mTc-perfusion agents do not redistribute and may underestimate viability compared to 201Tl or FDG

• Improvement for detection of viability with quantitative SPECT criteria and nitrate administration

Cuocolo A et al. J Nucl Med 1992;33:505-511. Soufer R et al. Am J Cardiol 1995;75:1214-1219. Altehoefer C et al. J Nucl Med 1994;35:569-574.

Page 8: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and
Page 9: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Conclusions • TMT was less sensitive than MPI for LCX

ischemia detection

• CAD and prior MI detected in a patient with no history

• MIBI was consistent with rest ECG, confirming the suspicion of a prior silent MI

• MIBI detected a large area of viable tissue at risk, not requiring any other test to decide management

• MIBI can be used as a viability agent, however underestimation of viable tissue may occur in some cases and further testing may be needed

Page 10: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Case

• 68 year-old woman with a history of silent inferior MI who presented with episodes of atrial fibrillation and ventricular tachycardia

• ECG:

– Q waves in II, III, AVF

• Coronary angiography:

– Occluded RCA with collaterals to the distal inferior wall from the left circulation

Page 11: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Rest only - 15 min Rest- 4h redistribution 201Tl

Page 12: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Membrane Integrity: Thallium-201

• Analog of potassium

– Myocardial extraction by active and passive transport

– High first pass uptake – 89%

– Myocardial localization: 4% injected dose

• Does redistribute according to perfusion

• Allows evaluation of perfusion and cell membrane integrity (a requirement for viability)

Page 13: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Vitola and Delbeke: Nuclear Cardiology and Correlative Imaging, Springer 2004, NY, Chapters 3 and 8

Page 14: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Membrane Integrity: 201Thallium SPECT Rest-4h redistribution - Semiquantitation

• Patterns of uptake in dysfunctional myocardium:

– Fixed defect: <50% of normal: transmural scar

– Fixed defect: 50-80% of normal: non-transmural scar

– Redistribution – Myocardium at risk - viable

Bax JJ et al. Eur J Nucl Med 1997;24:516-522.

Page 15: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Membrane Integrity: 201Thallium SPECT • Stress/Rest imaging

– 4-hour redistribution imaging:

• fixed defect frequently viable: 45% of fixed defects improve after revascularization.

– Resting imaging after reinjection of 201Tl improves viability assessment : 30-50% fixed defects at 4h redistribution show reversibility.

– 24-h redistribution imaging (in average additional 6%)

Kiat H et al. JACC 1988;12:1456-1463. Yang LD et al. JACC 1990;15:334-340. Dilsizian V et al. NEJM 1990;323:141-146.

Page 16: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Value of 24h imaging:

Small number of patients:

– Up to 30% of patients with fixed defects (rest-4 hrs) will show improved uptake at 24h

– But only 3% of patients with fixed defects of <50% uptake of normal

Membrane Integrity: 201Thallium SPECT

Wagdy HM et al. Nucl Med Commun 2002;23:629-637.

Matsunari I et al. J Nucl Med 1997;38:1073-1078.

Page 17: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

• 61 yo man with exercise induced chest pain (typical angina)

• AMI 2 1/2 y ago, followed by CABG: LIMA to LAD and SVG to the LCX

• Last cath 6 mo ago: 99% native LAD, occluded LIMA, antero-apical akinesia

•Meds: Carvedilol, ACEI, nitrate, ASA, Statin and Aldactone

Referred for a SESTAMIBI study

•MPI: Bruce, 10 METS, ECG positive – new ST depression 1 mm, denied chest pain

Case

Page 18: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Stress/Rest MIBI • Hx of exercise induced chest pain + new ST depression 1 mm om TMT

Page 19: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Stress/Rest MIBI

•exercise induced chest pain, new ST depression

Next Step ?

Page 20: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Nitrate administration

Venodilation

Preload reduction

Decrease of LV volume and wall stress

Reduction of myocardial oxygen demand

Coronary blood flow redistribution towards ischemic

regions by reduction of LV end-diastolic pressure

Page 21: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Nitrate Myocardial Perfusion Imaging

0 5 10 15 20 25 30 50 70

SPECT imaging

Nitrateadministration

Tracerinjection

Resting conditions

Time (min)

Page 22: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

MIBI with nitroglycerin (NTG)

Page 23: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Scar > Ischemia

MIBI without NTG

Ischemia > Scar

MIBI with NTG

STRESS

STRESS

REST

STRESS

REST

STRESS

REST

•exercise induced chest pain, new ST depression

Next Step : nitrate MIBI = good choice

REST

Page 24: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Rest without NTG Rest with NTG

STRESS STRESS

REST REST

Akinetic antero - apical region

Page 25: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Case

• 52 year-old man with CHF and global LV dysfunction on echocardiography

• Coronary angiography: severe 3-vessel CAD

Page 26: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and
Page 27: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

• Nitrate: How does it work?

– Preload reduction, some dilatation of stenotic epicardial vessel and improvement of collateral circulation

• How to administer?

– 0.4-0.8 mg sublingually 5 -10 min before the radiopharmaceutical

• Can be used with 201Tl or 99mTc-perfusion agents

• Performance?

Myocardial Viability Resting and nitrate-enhanced SPECT

Bisi G et al. JACC 1994;24:1282-1289.

Batista JF et al. J Nucl Cardiol 1999;6:480-486.

Oudiz RJ et al. Am Heart J 1999;138:206-209.

Page 28: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

FD

G

Viable Necrotic

Via

ble 75

(57%)

34

(26%)

3

(2%)

Necro

tic

19

(15%)

Baseline Tetrofosmin

Agreement: 94/131 (72%)

Kappa = 0.35

Nitrate Tetrofosmin

FD

G

Viable Necrotic

Via

ble 89

(68%)

20

(15%)

3

(2%)

Necro

tic

19

(15%)

Agreement: 109/131 (82%)

Kappa = 0.53

Cardiac Tomography After Nitrate Administration in Patients With

Ischemic LV Dysfunction: Relation to Metabolic Imaging by PET

He W, et al. J Nucl Cardiol 2003

Page 29: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Cardiac Tomography After Nitrate Administration in Patients

With Ischemic LV Dysfunction: Relation to Metabolic Imaging

by PET

He W, et al. J Nucl Cardiol 2003

Patient 1 Patient 2

Page 30: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

69

8681

86

0

20

40

60

80

100

Sensitivity Specificity

He W, et al. J Nucl Cardiol 2003

Perc

ent

Baseline

Nitrate

Sensitivity and Specificity of Baseline and Nitrate Tetrofosmin

SPECT for Detecting Preserved Metabolic Activity in Patients With

Ischemic LV Dysfunction

p < 0.01 p = NS

Page 31: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Detection of Myocardial Viability by Radionuclide Imaging

Gold Standard: Recovery of LV Function

9086

81

91 92

54

6760

88

73

0

20

40

60

80

100

Tl-201 Red Tl-201 Rein Mibi Mibi-Nitrate FDG-PET

Bax et al. J Am Coll Cardiol 1997

%

Sensitivity Specificity

Page 32: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Stunning

Scar from prior MI

Hibernation

Subendocardium

20-30 % = akinesia

May have lots

of viable tissue

Chronic cases =

Mixed pattern

Page 33: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Lieberman AN et al, Circulation 1981;63:739-746

Contribution of the subendocardium to contractility

Akinetic anterior wall

Page 34: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Pooled Data from Studies Focusing on Prediction of Recovery of Function Post-revascularization

Technique #Studies/

patients

Sensitivity Specificity NPV PPV

FDG PET 20/598 93% 58% 86% 71%

201Tl 33/858 87% 55% 81% 64%

99mTc-tracers 20/488 81% 66% 77% 71%

Dobutamine

Echo/MRI

32/1090 81% 80% 85% 77%

Pooled data 105/3034 84% 69%

Bax JJ et al. Curr Probl Cardiol 2001;26:142-186

Page 35: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Why is nuclear less specific compared to echo for Fx improvement ?

Qureshi U et al. Circulation 1997;95:626-635

Page 36: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Subendocardium MI may lead to akinesia

Akinetic segments may have lots of viable tissue detected by Nuclear

Scar may prevent improvement of function and detection by echo

Page 37: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Conclusions

• MIBI can be used as a viability agent, however underestimation of viable tissue may occur and further testing may be needed in special cases

• Nitrates are easy and safe to use and increase the sensitivity of rest MIBI to detect viable tissue

• There are data in the literature supporting the use of Nitrate MPI with similar accuracy to other protocols including thallium and FDG (LV Fx dependent)

• Akinetic areas may be present after a subendocardium MI

• Viability studies may show large quantities of viable tissue at risk in akinetic areas

Page 38: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

PET CT

Integrated PET-CT Imaging

System

PET

CT

PET - CT

Hybrid Technology - PET/CT Widespread due to oncology

Availability may push for more cardiac utilization

Page 39: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Cardiac PET/CT

PET/CT

Viability

Systolic/

Diastolic

function

First

Pass

Image

Fusion

CAC

Perfusion

Page 40: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

COMPLETE STATE OF THE ART EVALUATION IN 30 MINUTES ANATOMY, PERFUSION AND FUNCTION

Page 41: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Differences SPECT vs. PET Radiotracers

Characteristic SPECT PET

Radiotracer Generator Generator/Cyclotron

Energy 80-140 KeV 511KeV

Resolution 20 mm FWHM 10 mm FWHM

Attenuation More Less

Half-life 6 hrs-72 hrs 1.5 to 13 min

Radiation Greater Less

Study duration 3-4 hrs 35-45 min

Stress Exercise > pharm

Pharm > exercise

Page 42: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Estimated radiation dose to patients: PET vs. SPECT

Adapted from: Gerber et al.

Circulation, Feb 2009; 119: 1056 -

1065.

Einstein et al Circulation.

2007;116:1290-1305

Senthamizhchelvan J. Nucl. Med.

2011 52: 485-491

Stabin, Health Physics: December

2010 - Volume 99 - Issue 6 - pp 811-

813

Page 43: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

SPECT

• Flow heterogeneity to see the defect

• Homogenous decrease: • Three vessel disease, Left main

• Microvascular disease

Beanlands et al. J Am Coll Cardiol 2009 54: 157-159

Page 44: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

PET - Myocardial blood flow absolute quantification: Clinical applications

Diagnosis

Multivascular disease (Diffuse disease)

Microvascular disease

Evaluation of endothelial function

Patient’s treatment follow-up

Myocardial Viability

Page 45: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Advantages of Cardiac PET

• High image resolution

– Spatial, contrast and temporal

• Superior efficiency

– Time

– Radiation

• Superior ability to delineate extent of CAD

– Quantitative imaging capabilities

– Peak stress LVEF

– Hybrid PET/CT applications

Page 46: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Variable Soft Tissue Attenuation: SPECT

Stress

Rest

Stress

Rest

Stress

Rest

Page 47: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Variable Soft Tissue Attenuation on SPECT:

Normal 82 Rb PET

Stress

Rest

Stress

Rest

Stress

Rest

Stress

Rest

Page 48: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Limited Rest SPECT

Page 49: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Rb-82 Rest-Stress PET

Stress

Rest

Stress

Rest

Stress

Rest

Stress

Rest

Page 50: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Equivocal Tc 99m SPECT

5’6”, 190 lbs, F

Stress Tc 99m

Rest Tc 99m

Mildly Abnormal 82Rb PET

Stress Rb-82

Rest Rb-82

Page 51: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

Overall Diagnostic Accuracy

PET vs. SPECT

0

20

40

60

80

100

120

Sensitivity Specificity Accuracy

%

SPECT

PET

P<0.05

P<0.05

Bateman et al, J Nucl Cardiol; 2006:

Jan

86%

100%

ACC/ASNC Radionuclide guidelines

SPECT: Sensitivity 89%, Specificity:75%

Page 52: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

• FDG is taken up by viable myocardial regions

even when flow is significantly reduced.

• Effectively differentiates nontransmural MI

from hibernating condition.

• Soft tissue attenuation correction is routinely

performed.

PET FDG for Viability Assessment

Advantages over SPECT

Page 53: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

>50% uptake

Post-revascularization

Wall motion recovery

Not likely

Nontransmural MI Nontransmural MI

+

Hibernating myocardium

Post-revascularization

Wall motion recovery

likely

Page 54: PET/CT vs SPECT - Human Health Campus · PET/CT vs SPECT . 65 yo male Atypical chest pain No history of CAD/MI HTN, hypercholesterolemia Vitola and Delbeke: Nuclear Cardiology and

• PET FDG is the preferred imaging method for

assessment of myocardial viability.

• If SPECT is done first, PET should be

considered in those with non- or partially

reversible defects.

PET vs. SPECT for Viability Assessment