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Important properties of PET MPI with Rb-82

St. Luke's Hospital is committed to the goal of continuous quality improvement in our mission to be the area's premier provider of comprehensive health care. Since heart disease is the leading cause of death in the United States 1, its early and accurate diagnosis is of utmost importance to us.

Cardiac positron emission tomography (PET) with Rb-82 was first approved by the U.S. Food and Drug Administration (FDA) over two decades ago and was redefined as a "Class 1" procedure appropriate for routine clinical use by the American College of Cardiology, American Heart Association and the American Society of Nuclear Medicine in 1995. 2 Since that time, the application of PET and PET/computed tomography (CT) for cardiac imaging has become more robust and accessible due to increased numbers of scanners as well as numerous advances in technology. Now that PET and PET/CT have been optimized for cardiac imaging (we are proud to be the only hospital in the St. Louis area to offer this advanced imaging modality for detecting heart disease).

Important properties of PET myocardial perfusion imaging (MPI) with Rb-82:

1. High diagnostic accuracy: "Myocardial perfusion PET has high sensitivity and specificity for angiographically significant obstructive CAD, and has been shown in meta-analyses to outperform other noninvasive approaches." 3

2. Consistent high-quality images: Cardiac PET gives higher count images with better spatial resolution and "image quality is relatively unaffected by body shape or size, distinguishing PET from all other cardiac imaging modalities." 3 This allows us to obtain excellent diagnostic quality images even in large patients with suboptimal prior cardiac testing. Our state-of-the art PET scanner with a bore size of 78 cm, which is larger than most routine scanners including CT, MRI and SPECT/CT scanners, can accommodate patients of up to 500 pounds.

3. Low radiation exposure: Our 3D capable PET scanner obtains high quality images at the lowest radiation dose possible, with most scans exposing patients to radiation doses as little as 2 mSv. This is well below levels known to be associated with long-term adverse effects, and low in comparison to most radiation-based cardiac assessments" 3, an important factor in patients who need recurrent radiation based testing.

4. Short acquisition protocols: A complete rest/stress study is completed in approximately 30 minutes.* This is helpful in patients who can only remain still for a few minutes at a time, making it an ideal test for claustrophobic patients and patients who cannot tolerate laying flat for long periods of time.

5. Quantification of myocardial blood flow: Cardiac PET scan has the ability to routinely quantify myocardial blood flow, both at rest and after stress. This well validated assessment facilitates comprehensive assessment of the overall and regional myocardial blood flow, including epicardial and microvascular dysfunction beyond other routinely obtained parameters. 3

6. Residual Risk Assessment: In patients without known diagnosis of coronary artery disease, coronary artery calcium scores can be obtained to assess long term prognosis. 3 This is crucial for patients with no ischemia on the stress PET test.

7. Strong prognostic power: With the comprehensive non-invasive evaluation of the myocardium and coronary arteries, cardiac PET MPI provides high discrimination of risk stratification in patients for whom myocardial perfusion imaging is appropriate, including obese and non-obese people, men and women, diabetics, and patients with renal dysfunction.

*Only at St. Luke's Hospital, a complete gated rest/stress PET MPI procedure can be performed in as little as 30 minutes* for optimal patient comfort, convenience, and satisfaction.

We invite your feedback and suggestions on how we might better improve our imaging services. We appreciate your support and look forward to providing you and your patients with the best available healthcare, which now includes cardiac PET imaging.

For questions or for more information, please call and ask for a PET technologist at 314-205-6538. To schedule or to change a PET exam appointment, please call 314-205-6565.

1. Roger, V., et al. (2011). Heart Disease and Stroke Statistics 2011 Update: A Report From the American Heart Association.Circulation, doi: 10.1161/CIR.0b013e3182009701.
2. Mehrige, ME, et al. (2007). Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management. JNM, 48(7), 1069-1076.
3. Bateman, et al. (2009) ASNC/SNMMI POSITION STATEMENT. JNC, 1071-3581
* Additional time is required for patient preparation. Actual test times may vary based upon individual patient characteristics and environmental factors.