PET-based imaging of ischemic heart disease

This review surveys what cardiac PET brings to ischemic heart disease, from everyday diagnosis to the molecular frontier.

On the established ground, PET detects coronary disease with high accuracy, assesses whether heart muscle is still viable, and — distinctively — quantifies coronary flow reserve, the heart’s capacity to increase blood flow under demand. That last measure surfaces disease in the small vessels that other tests miss entirely. The authors also point ahead to molecular imaging of plaque and the vessel wall itself.

The practical takeaway is that PET outperforms the older SPECT workhorse on the metrics that matter, with the familiar caveat that scanners are costly and scarce, and centers invested in SPECT resist the switch.

We rate the evidence moderate: a 58-reference review in a reputable journal, no commercial conflicts, but a synthesis of prior literature rather than new data. Its clinical significance is likewise moderate — the flow-quantification and microvascular advantages are real and clinically useful, but limited availability keeps PET from being most patients’ test. A clear picture of where cardiac PET adds value, bounded by where you can actually get one.