Blach Anna, Kwiecinski Jacek
Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland.
Nuclear Medicine Department, Voxel Diagnostic Center, 40-514 Katowice, Poland.
J Pers Med. 2025 Mar 3;15(3):100. doi: 10.3390/jpm15030100.
Coronary artery disease remains the leading cause of morbidity and mortality worldwide. With the changing clinical manifestation and novel therapeutical options, precise disease phenotyping becomes increasingly important at the point of care. In the management of coronary artery disease, myocardial perfusion imaging (MPI) remains the cornerstone of clinical practice. Although traditionally MPI has been primarily performed with single photon emission computed tomography (SPECT), nowadays, given the changing spectrum of the disease, greater precision and additional assessment of myocardial blood flow are desired. Due to the fundamental advantages of PET over SPECT, i.e., higher spatial resolution, accurate attenuation correction for each scan, and higher count rates, the sensitivity and specificity of PET MPI are higher than those of SPECT MPI and are estimated to be approximately 90-92% vs. 83-88% and 81-87% vs. 70-76%, respectively, according to meta-analysis data. Consequently, over the past decade, we have witnessed an increased uptake of positron emission tomography (PET) MPI. With the improved spatial resolution, the ability to quantify myocardial blood flow, and the potential to depict the burden of coronary atherosclerosis with low-dose computed tomography, PET/CT is uniquely positioned to facilitate a comprehensive non-invasive assessment of disease, providing an opportunity for precision medicine. The wealth of data obtained during a single imaging session can be challenging to integrate at the time of image analysis. There has therefore been an increasing interest in developing predefined thresholds or variables (scores) which combine the multidimensional data acquired with PET MPI. Beyond MPI, PET can also serve for the assessment of disease activity at the atherosclerotic plaque level, further refining our understanding of the biology of coronary artery disease and providing hope for enhanced prediction of myocardial infarctions. In this narrative review, we present the current applications of PET MPI in coronary artery disease and focus specifically on two areas that have recently garnered considerable interest-the integration of multiparametric PET MPI data and coronary plaque activity PET imaging.
冠状动脉疾病仍然是全球发病和死亡的主要原因。随着临床表现的变化和新的治疗选择的出现，在医疗点进行精确的疾病表型分析变得越来越重要。在冠状动脉疾病的管理中，心肌灌注成像（MPI）仍然是临床实践的基石。虽然传统上MPI主要通过单光子发射计算机断层扫描（SPECT）进行，但如今，鉴于疾病谱的变化，人们期望更高的精度和对心肌血流的额外评估。由于PET相对于SPECT的基本优势，即更高的空间分辨率、每次扫描的准确衰减校正以及更高的计数率，根据荟萃分析数据，PET MPI的敏感性和特异性高于SPECT MPI，估计分别约为90 - 92%对83 - 88%以及81 - 87%对70 - 76%。因此，在过去十年中，我们目睹了正电子发射断层扫描（PET）MPI的使用增加。凭借改进的空间分辨率，可以量化心肌血流，并且有潜力通过低剂量计算机断层扫描描绘冠状动脉粥样硬化的负担，PET/CT具有独特的优势，能够促进对疾病进行全面的非侵入性评估，为精准医学提供了机会。在图像分析时，整合在一次成像过程中获得的大量数据可能具有挑战性。因此，人们越来越有兴趣开发预定义的阈值或变量（分数），以结合通过PET MPI获取的多维数据。除了MPI，PET还可用于评估动脉粥样硬化斑块水平的疾病活动，进一步完善我们对冠状动脉疾病生物学的理解，并为增强心肌梗死的预测提供希望。在这篇叙述性综述中，我们介绍了PET MPI在冠状动脉疾病中的当前应用，并特别关注最近引起广泛关注的两个领域——多参数PET MPI数据的整合和冠状动脉斑块活动PET成像。
