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Diagnosing coronary artery disease with hybrid PET/CT

Philips CT Clinical Science Philips Healthcare • USA

Paul Knaapen, MD PhD

Department of Cardiology

VU University Medical Center


The Netherlands


The non-invasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, non-invasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.

Clinical scenarios in PET/CCTA imaging. Hybrid PET/CCTA roughly categorizes patients into one of four scenarios (fusion images are displayed to co-localize perfusion and anatomy, and actual diagnostic images of multiplanar CCTA and multiple re-sliced perfusion images from base-to-apex are not shown).

  1. depicts a normal CCTA with normal quantitative perfusion, excluding coronary pathology.
  2. shows a lesion in the RCA and LAD with only a mild perfusion defect in the anteroseptal area, justifying a conservative approach or target vessel revascularization in case of persistent symptoms despite optimal medical treatment.
  3. displays a high grade lesion in the proximal LAD with a large perfusion defect requiring referral for ICA and revascularization.
  4. shows no CAD at CCTA, yet diffusely blunted hyperemic MBF compatible with coronary microvascular dysfunction. CCTA, Coronary computed tomography angiography; RCA, right coronary artery; LAD, left anterior descending artery; CAD, coronary artery disease; MBF, myocardial blood flow.

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Nov 8, 2017

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13th MDCT Users Meeting abstracts, atherosclerosis, Cardiac, coronary angiography, coronary arteries, coronary artery disease, LAD, lesion, myocardial perfusion, RCA, Vascular

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