Role of FDG-PET in Evaluation of Myocardial Viability

Should patients with an incidental finding of focal myocardial 18FDG uptake be screened by myocardial perfusion scintigraphy?

“…However, it is increased on 18 FDG PET/CT in a context of resting ischemia, even without clinical or ECG signs in patients with unstable angina [4]. Myocardial glucose utilization is also increased in viable myocardium after myocardial infarction and 18 FDG PET is currently the method of reference to assess the viability [9,20]. Since glucose metabolism in the fasting state is heterogeneous and unpredictable even in the normal myocardium, it is challenging to diagnose the presence of CAD by fasting 18 FDG PET imaging alone, at rest.…”

“…Focal 18 FDG uptake in the myocardium can be a sign of myocardial ischemia [7], which can include silent ischemia at rest, silent ischemia at stress and hibernating myocardium after a myocardial infarction [8]. This specificity is used in clinical routine to assess myocardial viability in patients who are potential candidates for revascularization procedures after a myocardial infarction, and 18 FDG PET/CT is now the method of reference for this assessment [9,10]. Myocardial viability in 18 FDG PET/CT can be assessed following a strict protocol of glucose-insulin loading to force the myocardium metabolism toward glucose utilization [11].…”

Programmatic approach to patients with advanced ischemic cardiomyopathy: Integrating microaxial support into strategies for the modern era

“…Primarily, position emission topography (PET) with fluorodeoxyglucose (FDG) and cardiac magnetic resonance imaging (MRI) are employed. Through FDG‐PET scans, the degree of myocardial perfusion and metabolic activity can be assessed 27 . Myocardium with preserved metabolic activity likely represents recoverable territory.…”

CABG in Failing Hearts: A How-to-Guide to Using Modern Mechanical Support as Backup

“…Physiologic assessment is best done using resting and stress positron emission topography (PET) with fluorodeoxyglucose which evaluates for both myocardial perfusion and myocardial metabolic activity. 12 Myocardium with normal perfusion indicates viable myocardium. If myocardium has decreased perfusion but has preserved metabolic activity, it is still viable but recovery may be delayed.…”