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Cardiac PET (or cardiac positron emission tomography) is a form of diagnostic imaging in which the presence of heart disease is evaluated using a PET scanner. Intravenous injection of a radiotracer is performed as part of the scan. Commonly used radiotracers are Rubidium-82, Nitrogen-13 ammonia and Oxygen-15 water.

Uses

Cardiac PET-CT scan can assess blood flow, metabolism, inflammation, innervation, and receptor density accurately. Besides, it is also useful to detect heart conditions such as coronary artery disease, cardiac amyloidosis, and cardiac sarcoidosis.

Radiopharmaceuticals

Rubidium-82 is produced from the decay of Strontium-82 through electron capture in a generator. It is used to access the blood vessels supplying the heart. Strontium-82 has a half-life of 25.5 days while Rubidium-82 has a half-life of 76 seconds. Heart muscles can take up Rubidium-82 efficiently through sodium–potassium pump. Compared with Technetium-99m, Rubidium-82 has higher uptake by the heart muscles. However, Rubidium-82 has lower uptake by heart muscles when compared to N-13 ammonia. But the positron energy emitted by Rubidium-82 is higher than N-13 ammonia and Fluorodeoxyglucose (18F). On the other hand, the positron range (the distance travelled by a positron from its production site until its annihilation with an electron) is longer when compared to other radiopharmaceuticals, causing reduced image resolution.

Myocardium has higher uptake for N-13 ammonia when compared to Rubidium-82, thus useful for myocardial perfusion imaging. However, its half-life is only 9.96 minutes. Therefore, on-site facilities such as cyclotron and radiochemistry synthesis facilities should be available. There may be patchy uptake if the subject has defects in lateral ventricular wall. N-13 ammonia may occasionally be degraded by liver, thus causing reduced visibility of the inferior wall of the heart. N-13 ammonia uptake by the lungs is minimal.

Indications

• Patients with many risk factors e.g. hypertension, high cholesterol, smoking habit, diabetes, obesity, high stress occupation, family history of heart attack
• Patients who are unable to exercise
• Patients suspected of heart attack
• Patients newly diagnosed with heart failure
• Patients with abnormal ECG or treadmill

Requirements

• Facility: taking into consideration clinical workflow, as well as regulatory requirements such as requisite shielding from radiation exposure
• Capital equipment: PET or PET/CT scanner
• Radiopharmaceutical: Rubidium-82 generator system or close access to cyclotron produced isotopes such as Nitrogen-13 ammonia
• Personnel: including specially trained physician, radiographers, radiation safety supervisors and optional nursing support
• Operations: stress test monitoring, as well as emergency response equipment, processing and review workstations, administrative and support personnel are additional considerations

References

1. Ghosh, N; Rimoldi OE; Beanlands RS; Camici PG (December 2010). "Assessment of myocardial ischaemia and viability: role of positron emission tomography". European Heart Journal. 31 (24): 2984–2995. doi:10.1093/eurheartj/ehq361. PMID 20965888.
2. ^ Di Carli, Marcelo F.; Dondi, Maurizio; Giubbini, Raffaele; Paez, Diana, eds. (2022). IAEA Atlas of Cardiac PET/CT: A Case-Study Approach. Berlin, Heidelberg: Springer Berlin Heidelberg. doi:10.1007/978-3-662-64499-7. ISBN 978-3-662-64498-0. S2CID 248368314.

v t e Tests and procedures involving the heart
Cardiac surgery Interventional cardiology Cardiology diagnostic tests and procedures Cardiac imaging
Surgery	Heart valves and septa Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Transcatheter Mitral valve replacement Transcatheter pulmonary valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock–Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of the great vessels Arterial switch operation Mustard procedure Senning procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock–Taussig shunt SVC to the right PA Glenn procedure Cardiac vessels CHD Angioplasty Bypass/Coronary artery bypass MIDCAB Off-pump CAB TECAB Coronary stent Bare-metal stent Drug-eluting stent Obstacle removal Endarterectomy Atherectomy Bentall procedure Valve-sparing aortic root replacement LeCompte maneuver Other Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure (Cox maze and minimaze) Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion S-ICD implantation ICD implantation Cardiac resynchronization therapy Left atrial appendage occlusion Cardiotomy Heart transplantation
Tests	Electrophysiology Electrocardiography Vectorcardiography Holter monitor Implantable loop recorder Cardiac stress test Bruce protocol Electrophysiology study Cardiac imaging Angiocardiography Echocardiography TTE TEE Myocardial perfusion imaging Cardiovascular MRI Ventriculography Radionuclide ventriculography Cardiac catheterization/Coronary catheterization Cardiac CT Cardiac PET sound Phonocardiogram
Function tests	Impedance cardiography Ballistocardiography Cardiotocography
Pacing	Cardioversion Transcutaneous pacing
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