Acquisition, Processing, and Interpretation of PET 18F-FDG Viability and Inflammation Studies

Abstract

This article reviews the acquisition protocols and image interpretation for 18F-fluorodeoxyglucose (18F-FDG) imaging with positron emission tomography (PET) applied to the evaluation of myocardial viability and inflammation. Cardiac PET with 18F-FDG provides essential information for the assessment of myocardial viability and inflammation and is usually combined with PET perfusion imaging using 82Rb or 13N-ammonia. Viable myocardium maintains glucose metabolism which can be detected via the uptake of 18F-FDG by PET imaging. The patient is prepared for viability imaging by shifting the metabolism of the heart to maximize the uptake of glucose and hence of 18F-FDG. Comparison of the 18F-FDG and myocardial perfusion images allows distinction between regions of the myocardium that are hibernating and thus may recover function with intervention, from those that are infarcted. Increased glucose utilization in the inflammatory cells also makes 18F-FDG a useful imaging technique in conditions such as cardiac sarcoidosis. Here, suppression of normal myocardial uptake is essential for accurate image interpretation. 18F-FDG PET broadens the scope of information potentially available through a cardiac PET study. With careful patient preparation, it provides valuable insights into myocardial viability and inflammatory processes such as sarcoidosis.