Cardiac PET Imaging, it’s here.

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You can refer your patient for a cardiac PET scan appointment via our online patient portal.

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Refer your patient for a cardiac PET scan appointment by directly calling our office.

818-925-2480

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Indications for Cardiac PET

Cardiac PET: Myocardial Perfusion Imaging- Appropriate Use Criteria

Detection of CAD in the symptomatic patient:

▪️ Evaluation of Ischemic Equivalent (Non-Acute)

▪️ Acute Chest Pain

▪️ Acute chest pain (rest imaging only )

Risk Assessment: Preoperative Evaluation for Non-Cardiac Surgery without Active Cardiac Conditions*

▪️ Intermediate-Risk Surgery

▪️ Vascular Surgery

Detection of CAD/Risk Assessment without Ischemic Equivalent

▪️ Asymptomatic- High CHD Risk (ATP III Risk Criteria)

▪️ New-Onset or Newly diagnosed Heart Failure with LV Systolic Dysfunction without Ischemic Equivalent

▪️ Ventricular Tachychardia

▪️ Syncope with Intermediate or High CHD risk (ATP III Risk Criteria)

▪️ Troponin elevation without additional evidence of acute coronary syndrome

Risk Assessment: Within 3 months of an Acute Coronary Syndrome

1. STEMI

2. UA/NSTEMI

3. Risk Assessement: Post Revascularization (PCI or CABG)

▫️ Symptomatic

▫️ Asymptomatic- Incomplete Revascularization or greater than or equal to 5 years post CABG

Assessment of Viability/Ischemia

▪️ Ischemic Cardiomyopathy

▪️ Assessment of Viability for patient eligible for revascularization.

Evaluation of Left Ventricular Function

▪️ In absence of recent reliable diagnostic information from another imaging modality

▪️ Baseline and serial measures after key therapeutic milestones or evidence of toxicity from potentially cardiotoxic therapy

Risk Assessment with prior test results and/or known chronic stable CAD

▪️ Equivocal, borderline or discordant stress testing where obstructive CAD remains a concern. An inconclusive test is a test(s) whose results are equivocal, technically uninterpretable, or discordant with a patient’s other clinical data

▪️ New or worsening symptoms- Abnormal coronary angiography OR abnormal prior stress imaging study

▪️ Coronary stenosis or anatomic abnormality of uncertain significance

▪️ Asymptomatic, High CHD risk, Agatston score between 100-400

▪️ Asymptomatic, Agatston score greater than 400

▪️ Asymptomatic, Intermediate-Risk Duke Treadmill Score

▪️ Asymptomatic, High-Risk Duke Treadmill Score

Cardiac PET: Myocardial Viability

The applications for Cardiac Viability Imaging with FDG PET are:

1. The identification of patients with partial loss of heart muscle movement or hibernating myocardium is important in selecting candidates with compromised ventricular function to determine appropriateness for revascularization.

2. Distinguish between dysfunctional but viable myocardial tissue and scar tissue in order to affect management decisions in patients with ischemic cardiomyopathy and left ventricular dysfunction.

Medicare covers FDG PET for the determination of:

1. Myocardial viability as a primary or initial diagnostic study prior to revascularization, or following an inconclusive SPECT. Studies performed by full and partial ring scanners are covered.

2. Limitations: In the event a patient receives a SPECT test with inconclusive results, a PET scan may be covered. However, if a patient receives a FDG PET study with inconclusive results, a follow up SPECT test is not covered.

Cardiac PET Publications

GENERAL INFORMATION

ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures

Journal of Nuclear Cardiology 2016

CORONARY FLOW RESERVE

Clinical Quantification of Myocardial Blood Flow Using PET

Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. Journal of Nuclear Cardiology 2017.

Coronary Physiology Beyond Coronary Flow Reserve in Microvascular Angina, by K. Lance Gould, MD, Nils P. Johnson, MD, MS. Journal of the American College of Cardiology 2018.

A JACC State-of-the-Art Review

Myocardial blood flow reserve assessed by positron emission tomography myocardial perfusion imaging identifies patients with a survival benefit from early revascularization. European Heart Journal 2020.

Myocardial blood flow reserve on PET MPI is associated with all-cause mortality and can identify patients who re- ceive a survival benefit with early revascularization compared to medical therapy.

CORONARY ARTERY DISEASE

Cardiac PET/CT for the Evaluation of Known or Suspected Coronary Artery Disease Radiographics 2011

an excellent review of the technical, diagnostic and prognostic performance of PET myocardial perfusion imaging.

CMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging. Journal of the American College of Cardiology 2009.

Appropriate use guidelines document classifying indications for cardiac PET.

ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging. Journal of the American College of Cardiology 2003.

Clinical scenarios and indications for nuclear stress testing techniques.

MYOCARDIAL VIABILITY

Myocardial Viability Assessment Before Surgical Revascularization in Ischemic Cardiomyopathy. Journal of the American College of Cardiology 2021.

In this paper, the authors describe a more contemporary application of viability testing that is founded on the alternative concept that the main goal of surgical revascularization is to prevent further damage by protecting the residual viable myocardium from subsequent acute coronary events.

State of the Art: Imaging for Myocardial Viability. Circulation: Cardiovascular Imaging 2020.

A Scientific Statement From the American Heart Association.

CARDIAC SARCOID

Cardiac Positron Emission Tomography Enhances Prognostic Assessments of Patients with Suspected Cardiac Sarcoidosis. Journal of the American College of Cardiology 2014.

The presence of focal perfusion defects and FDG uptake on cardiac PET identifies patients at higher risk of death or VT.

Pre-Treatment Myocardial 18-FDG Uptake Predicts Response to Immunosuppression in Patients With Cardiac Sarcoidosis. Journal of the American College of Cardiology 2021.

Pre-treatment 18-FDG myocardial uptake was a predictor of clinical response and echocardiographic response response to immunosuppression in patients with cardiac sarcoid.

PET VS SPECT

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.

In a large population of matched pharmacologic stress patients, myocardial perfusion PET was superior to SPECT in image quality, interpretive certainty, and diagnostic accuracy.