Centre for Clinical Research, Biomedical Research Foundation of the Academy of Athens, Greece.
Int J Cardiol. 2013 Sep 1;167(5):1737-49. doi: 10.1016/j.ijcard.2012.12.009. Epub 2013 Jan 11.
An important evolution has taken place recently in the field of cardiovascular Positron Emission Tomography (PET) imaging. Being originally a highly versatile research tool that has contributed significantly to advance our understanding of cardiovascular physiology and pathophysiology, PET has gradually been incorporated into the clinical cardiac imaging portfolio contributing to diagnosis and management of patients investigated for coronary artery disease (CAD). PET myocardial perfusion imaging (MPI) has an average sensitivity and specificity around 90% for the detection of angiographically significant CAD and it is also a very accurate technique for prognostication of patients with suspected or known CAD. In clinical practice, Rubidium-82 ((82)Rb) is the most widely used radiopharmaceutical for MPI that affords also accurate and reproducible quantification in absolute terms (ml/min/g) comparable to that obtained by cyclotron produced tracers such as Nitrogen-13 ammonia ((13)N-ammonia) and Oxygen-15 labeled water ((15)O-water). Quantification increases sensitivity for detection of multivessel CAD and it may also be helpful for detection of early stages of atherosclerosis or microvascular dysfunction. PET imaging combining perfusion with myocardial metabolism using (18)F-Fluorodeoxyglucose ((18)F FDG), a glucose analog, is an accurate standard for assessment of myocardial hibernation and risk stratification of patients with left ventricular dysfunction of ischemic etiology. It is helpful for guiding management decisions regarding revascularization or medical treatment and predicting improvement of symptoms, exercise capacity and quality of life post-revascularization. The strengths of PET can be increased further with the introduction of hybrid scanners, which combine PET with computed tomography (PET/CT) or with magnetic resonance imaging (PET/MRI) offering integrated morphological, biological and physiological information and hence, comprehensive evaluation of the consequences of atherosclerosis in the coronary arteries and the myocardium.
近年来，心血管正电子发射断层扫描（PET）成像领域发生了重要的演变。作为一种原本具有高度通用性的研究工具，它为我们深入了解心血管生理学和病理生理学做出了重大贡献，现在逐渐被纳入临床心脏成像组合，用于诊断和管理接受冠状动脉疾病（CAD）检查的患者。正电子心肌灌注成像（MPI）检测有意义的 CAD 的平均灵敏度和特异性约为 90%，也是一种用于预测疑似或已知 CAD 患者预后的非常准确的技术。在临床实践中，铷-82（(82)Rb）是最广泛用于 MPI 的放射性药物，可提供准确且可重复的绝对定量（ml/min/g），与回旋加速器产生的示踪剂（如氮-13 氨（(13)N-ammonia）和氧-15 标记水（(15)O-water））获得的定量结果相当。定量增加了对多血管 CAD 的检测灵敏度，还可能有助于检测动脉粥样硬化的早期阶段或微血管功能障碍。使用葡萄糖类似物氟-18 氟代脱氧葡萄糖（(18)F-FDG）结合灌注和心肌代谢的 PET 成像，是评估心肌冬眠和缺血性左心室功能障碍患者危险分层的准确标准。它有助于指导血运重建或药物治疗的管理决策，并预测血运重建后症状、运动能力和生活质量的改善。引入将 PET 与计算机断层扫描（PET/CT）或磁共振成像（PET/MRI）相结合的混合扫描仪，可以进一步提高 PET 的优势，提供综合的形态学、生物学和生理学信息，从而全面评估冠状动脉和心肌中动脉粥样硬化的后果。
