PET Myocardial Perfusion and Glucose Metabolism Imaging: Part 2 — Interpretation and Reporting

This is the second half of a two-part ASNC guideline, and it picks up where the first leaves off. Where the companion document covered how to acquire a cardiac PET scan, this one covers how to read it and how to write it down.

Its clinical heart is the interpretation of perfusion paired with glucose metabolism — the combination that distinguishes viable, hibernating heart muscle from irreversible scar. That distinction is not academic: it can determine whether a patient with weakened heart function should be sent for revascularization, on the expectation that restoring blood flow will revive muscle that is merely stunned, or spared a procedure that would only open vessels feeding dead tissue. The guideline standardizes how images are interpreted and how findings are communicated so that this consequential read is made consistently.

The honest framing matches its companion. This is a procedural and interpretive standards document for the imaging laboratory, grounded in expert consensus rather than outcomes trials, and aimed at the physician reading the scan rather than the one deciding whether to order it.

We rate the evidence moderate. Its contribution is real but specialized: it brings rigor and uniformity to a powerful viability assessment, ensuring that when PET is used to guide a major treatment decision, the answer it gives means the same thing in every reading room.