Dr. Stephen Richard Underwood,
This session featured four eminent cardiologists with experience in both SPECT and PET imaging of myocardial perfusion and viability. SPECT has for a long time been the bread and butter of assessing coronary function although there is now overlap between its capabilities and those of stress echocardiography and magnetic resonance. In the radionuclide field PET has the ability to measure perfusion in absolute terms and the images are higher resolution although it is a more complex and expensive technique that is generally restricted to large academic centres. More recently, the availability of rubidium-82 generators has meant that routine perfusion imaging has been more accessible.
Marcus Schwaiger from Munich reviewed PET radiopharmaceuticals and highlighted the breadth of information that can be obtained on myocardial metabolism and vascular inflammation using the wide range of tracers that can be labelled with fluorine-18. Nonetheless he concluded that PET remains a research tool, suggesting that the complexity and cost of PET is still too high for widespread use outside the research setting.
Juhani Knuuti from Turku routinely uses oxygen-15 water as a perfusion tracer and provides quantitative images of myocardial perfusion reserve. He demonstrated convincingly the ability of PET-CT to combine anatomical and functional information and to detect abnormal coronary function when it may not be apparent on conventional SPECT.
Danilo Neglia from Pisa reviewed the evidence for the clinical value of myocardial perfusion PET, which is impressive. In a centre with access to both SPECT and PET he concluded “why not?” to the question whether PET was ready for clinical use.
Thomas Schindler from Geneva described the undoubted strengths of PET for perfusion imaging but also described the advances being made in SPECT with attenuation correction and new reconstruction techniques that produce high quality SPECT images with lower doses of tracer, reducing radiation burden to the patients.
In general discussion it was agreed that SPECT is still the work-horse for the assessment of coronary function and is likely to remain so until the cost and availability of PET improves. However, it looks increasingly likely that a cheaper dedicated cardiac PET camera combined with a fluorine-18 labelled perfusion tracer will move the field much more towards PET, provided that the ratio of cost to benefit is not too high.
Clinical positron emission tomography (PET): ready for routine use?
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