PET Advantages¹

// Better Economics
// Improved Efficiency
// Lower Radiation Exposure
// Fewer Attenuation Artifacts
// Improved Resolution

Cardiac PET is Suitable for Patients^2-5 

// With diffuse, balanced, or multivessel CAD
// With physical characteristics that may result in a suboptimal SPECT scan
// Whose prior SPECT scan did not correlate with other findings or with clinical impression
// Unable to exercise
// Whose situation requires results be obtained as quickly as possible; e.g., evaluation of chest pain and add-ons

Diagnostic Accuracy⁶

In a 2005 review, eight studies that compared perfusion PET with coronary angiography, representing a total of nearly 800 patients, were summarized, and a mean sensitivity of 93% and specificity of 92% for detection of significant CAD were observed. A more recent review, reporting a weighted sensitivity of 90% and specificity of 89% from 9 studies including 877 patients, scanned mostly with 82Rb PET, confirmed these results. For detection of myocardial ischemia, myocardial perfusion PET is considered to have superior diagnostic accuracy when compared with the more widely available and more frequently used SPECT technique. Available published reports comparing PET and SPECT have also been recently reviewed. The robust methods for attenuation correction with PET reduce the number of false-positive scans due to attenuation artefacts, and specificity is increased. This is of particular importance in obese populations and women, where attenuation artefacts are frequent. Perfusion PET also tends to be more sensitive than SPECT, which can be explained by better spatial resolution and better tracer extraction at high flow, allowing for detection of more subtle perfusion abnormalities.

Monitoring Therapy with Cardiac PET

The advances in cardiac PET also interact powerfully with documentation that vigorous pharmacologic and lifestyle management stabilize plaque, partially reverse coronary artery disease (CAD), and decrease cardiac events by 90% at long-term follow-up. Cardiac PET has been demonstrated to be the single most powerful non-invasive tool for the integrated tasks of identifying early coronary artery stenosis or diffuse disease, assessing severity of stenosis, objectively determining need for revascularization procedures, following progression or regression of disease, and directly evaluating endothelial function of the coronary arteries as a marker of early atherosclerosis.

The integration of diagnostic imaging with intense medical treatment as a combined subspecialty service has catapulted cardiac PET treatment programs into the same conceptual category as diagnostic therapeutic invasive cardiology. These scientific advances are now routinely applicable for physicians and patients who recognize and wish to pursue this approach to the management of CAD.

The algorithm to follow has been used successfully by Dr. Gould and Merhige respectively within their institutions resulting in documented reversal of disease, avoidance of downstream procedures, improved patient outcomes and an overall reduction of healthcare costs.

Chest Pain - Emergency Room Based PET

The molecular imaging approach with PET provides significant advantages over the conventional chest pain model. The conventional protocol requires a 23-hour observation period, serial enzymes and other blood tests. This approach is problematic for two reasons. It isn’t as accurate as dedicated imaging studies. In addition, the conventional protocol is more expensive, and it places a greater workflow burden on staff. The PET protocol can reduce the ER stay from 23 hours to one to two hours, and it reduces personnel costs and requires fewer blood tests and EKGs. In addition, the number of unnecessary, and normal, invasive coronary angiograms is reduced. It is rare for cardiologists experienced with PET
technology to subject normal individuals to invasive testing.

For more information about the Attrius click here.

Contact us directly:  attrius@positron.com


 

References

1. Bateman TM. PET Myocardial Perfusion Imaging: Making the Transition to a Clinical Routine. Appl Imaging: Applications NuclCardiol. 2002; 3(1): 1-6
2. Bateman, TM, Heller, GV, McGhie, IA, et. al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: comparison with ECG-gated Tc-99m Sestamibi SPECT. Journal of Nuclear Cardiology. 2006;13:24-33.
3. Nandalur, KR, Dwamena, BA, Choudhri, AF, et al. Diagnostic performance of positron emission tomography in the detection of coronary artery disease: a meta-analysis. Academic Radiology. 2008; 15:444-451
4. Merhige ME, Breen WJ, Shelton V, et al. Impact of myocardial perfusion imaging with PET and (82)Rb on downstream invasive procedure utilization, costs, and outcomes in coronary disease management. J Nucl Med.2007;48:1069-1076.
5. Bateman, TM. Cardiac positron emission tomography and the role of adenosine pharmacologic stress. American Journal of Cardiology.2004; 94:19-24. 5. Gould, KL. Reversal of coronary atherosclerosis: clinical promise as the basis for non-invasive management of coronary artery disease. Circulation. 1994;90:1558-1571. 
6. Nuclear Medicine Self-Study Program III: Nuclear Medicine Cardiology. Botvinik, EH, Ed. 1998: Society of Nuclear Medicine, Reston, VA.
7. Comparison of cost-effectiveness and utility of exercise ECG, single photon emission computed tomography, positron emission tomography, and coronary angiography for diagnosis of coronary artery disease. Patterson RE, Eisner RL, Horowitz SF. Carlyle Fraser Heart Center, Emory, Atlanta, GA. Circulation. 1995 Jan 1;91(1):54-65.

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