Myocardial perfusion PET promoted by ASNC and SNMMI: New guidelines
The American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) have published a jointly developed position statement on the clinical indications for myocardial perfusion positron emission tomography (PET) and updated guidelines and standards for PET nuclear cardiology procedures.
Myocardial perfusion PET offers a unique ability to quantify myocardial blood flow. Radiation exposure is low and diagnostic accuracy is high, even for large and obese patients. Image acquisition is rapid, an average of approximately five minutes. The exam also has the ability to accurately risk stratify patients with a wide array of clinical presentations.
In spite of these attributes, ASNC and SNMMI have noted significant underutilization of myocardial perfusion PET relative to its demonstrated advantages for patients being assessed for suspected clinically important coronary artery disease (CAD). The societies developed a position statement “to succinctly summarize the properties that make myocardial perfusion PET most useful in the diagnosis and management of the CAD patient, and to provide general guidance as to when it should be considered for optimal patient care.”
With more than 25 global experts in SPECT and PET contributing, the PET position statement provides an expert consensus on the clinical indications for myocardial perfusion PET imaging. The position statement upgrades PET to a preferred test for patients who meet criteria for stress imaging but are unable to complete a diagnostic-level of exercise. The statement also identifies five distinct clinical situations where cardiac PET is recommended. These include patients who have had a poor quality, equivocal,, or inconclusive prior stress-image study; when myocardial blood flow quantification is a needed adjunct to image findings; younger patients, patients with body characteristics that affect image quality; and higher-risk patients.
The open access 40 page guideline document published in the Journal of Nuclear Cardiology, an update to 2009 ASNC-developed guidelines, is designed for physicians and technologists who are qualified to practice nuclear cardiology. In addition to a 158-item list of references, subjects covered in depth include:
- An overview of PET, PET/CT and PET/MR instrumentation
- Quality control for PET, PET/CT and PET/MR imaging
- PET acquisition and processing parameters
- PET myocardial perfusion imaging - including patient preparation, cardiac stress testing, and Rb perfusion imaging
- Image display, normalization, and evaluation for technical assessment
- PET imaging of glucose metabolism
- Detection of inflammation and infection
- Reporting of myocardial perfusion and metabolism PET studies
- A sample protocol for IV glucose loading
- Detection of inflammation and infection.
“This updated guideline provides the most up-to-date information to support physicians and technologists in appropriate patient selection and procedure performance standards. For diagnosing coronary artery disease, myocardial perfusion PET imaging outperforms other tests,” commented Vasken Dilsizian, MD, lead author of the guidelines and professor of radiology and medicine at the University of Maryland School of Medicine in Baltimore.
The guideline can be accessed here: http://www.asnc.org/content.asp?admin=Y&contentid=343
REFERENCES
- Bateman T, Dilsizian V, Beanlands R, et al. ASNC/SNMMI Position Statement on the Clinical Indications for Myocardial Perfusion PET. J Nucl Med. Published online August 25, 2016. (pii: jnumed. 116.180448).
- Dilsizian V, Bacharach SL, Beanlands RS, et al. ANSC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol. Published online July 8, 2016. (PMID: 27392702).