PET-determined myocardial perfusion and flow in coronary artery disease characterization

This concise review revisits PET’s distinctive ability to put a number on blood flow to the heart muscle — and what that number reveals about coronary disease at every stage.

The authors emphasize quantification of myocardial blood flow and flow reserve, which lets PET detect what anatomy-focused tests miss: early atherosclerosis before it obstructs, coronary microvascular dysfunction, and the diffuse, balanced reduction in flow that can hide on relative-perfusion images. The result is sharper characterization in exactly the patients conventional testing leaves ambiguous.

The practical takeaway is that PET flow measurement supports more personalized decisions — identifying microvascular disease and diffuse ischemia that change management. The resistance is the familiar one: angiography- and SPECT-centric practice, reimbursement, and limited PET access.

We rate the evidence moderate: a 34-reference narrative review with a solid mechanistic and clinical rationale, no new trial data, no conflicts. Its clinical significance is moderate — the flow-quantification advantage is real and clinically useful, capped by PET availability. It closes out a cluster of PET reviews in this library that collectively make one point: measuring flow, not just spotting blockages, is where cardiac PET earns its keep.