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      Positron Emission Tomography in the Diagnosis and Management of Coronary Artery Disease

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          Abstract

          Cardiac positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) are encouraging precise non-invasive imaging modalities that allow imaging of the cellular function of the heart, while other non-invasive cardiovascular imaging modalities are considered to be techniques for imaging the anatomy, morphology, structure, function and tissue characteristics. The role of cardiac PET has been growing rapidly and providing high diagnostic accuracy of coronary artery disease (CAD). Clinical cardiology has established PET as a criterion for the assessment of myocardial viability and is recommended for the proper management of reduced left ventricle (LV) function and ischemic cardiomyopathy. Hybrid PET/CT imaging has enabled simultaneous integration of the coronary anatomy with myocardial perfusion and metabolism and has improved characterization of dysfunctional areas in chronic CAD. Also, the availability of quantitative myocardial blood flow (MBF) evaluation with various PET perfusion tracers provides additional prognostic information and enhances the diagnostic performance of nuclear imaging.

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          Most cited references76

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          2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure.

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            A positron-emission transaxial tomograph for nuclear imaging (PETT).

            An apparatus was developed for obtaining emission transaxial images of sections of organs containing positron-emitting radiopharmaceuticals. The detection system is a hexagonal array of 24 NaI(T1) detectors connected to coincidence circuits to achieve the "electronic" collimation of annihilation photons. The image is formed by a computer-applied algorithm which provides quantitative reconstruction of the distribution of activity. Computer simulations, phantom and animal studies show that this approach is capable of providing images of better contrast and resolution than are obtained with scintillation cameras. Advantages of positron vs. single photon reconstruction tomography are discussed.
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              Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease.

              There have been limited data regarding the value of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the detection of left main coronary artery disease (CAD). We studied 101 patients with angiographic left main CAD (> or = 50% stenosis) and no prior myocardial infarction or coronary revascularization who underwent gated exercise or adenosine stress technetium 99m sestamibi SPECT MPI. By perfusion assessment alone, high-risk disease with moderate to severe defects (> 10% myocardium at stress) was identified in only 56% of patients visually and 59% quantitatively. Absence of significant perfusion defect (> or = 5% myocardium) was seen in 13% of patients visually and 15% quantitatively. However, by combining visual perfusion data and nonperfusion variables, especially transient ischemic dilation, 83% of patients were identified as high risk. The findings of this study demonstrate that assessment of perfusion data alone by visual or quantitative SPECT MPI analysis underestimates the magnitude of left main CAD. The combination of perfusion and nonperfusion abnormalities on gated MPI identifies high risk in most patients with left main CAD.
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                Author and article information

                Journal
                Medicina (Kaunas)
                medicina
                Medicina
                MDPI
                1010-660X
                1648-9144
                11 July 2018
                July 2018
                : 54
                : 3
                : 47
                Affiliations
                [1 ]Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania; Diana.Peksiene@ 123456kaunoklinikos.lt (D.Ž.-P.); egle.rumbinaite@ 123456gmail.com (E.R.); justas.kersulis@ 123456gmail.com (J.K.); Renaldas.Jurkevicius@ 123456kaunoklinikos.lt (R.J.)
                [2 ]Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania; kulakiene@ 123456dr.com
                Author notes
                [* ]Correspondence: e.kazakauskaite@ 123456yahoo.com ; Tel.: +370-610-639-81
                Article
                medicina-54-00047
                10.3390/medicina54030047
                6122121
                30344278
                e5a69209-7c3c-4fa5-8431-50cca50c8b8f
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 18 June 2018
                : 03 July 2018
                Categories
                Review

                positron emission tomography,coronary artery disease,myocardial viability,myocardial perfusion imaging

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