Review: comparison of PET rubidium-82 with conventional SPECT myocardial perfusion imaging

Abstract

Nuclear cardiology has for many years been focused on gamma camera technology. With ever improving cameras and software applications, this modality has developed into an important assessment tool for ischaemic heart disease. However, the development of new perfusion tracers has been scarce. While cardiac positron emission tomography (PET) so far largely has been limited to centres with on-site cyclotron, recent developments with generator produced perfusion tracers such as rubidium-82, as well as an increasing number of PET scanners installed, may enable a larger patient flow that may supersede that of gamma camera myocardial perfusion imaging.

Keywords: cardiac PET; cardiac SPECT; cardiology; myocardial perfusion imaging; rubidium.

Figure 1

⁸²Rb Cardiac PET; pharmacological stress test (adenosine) and rest test of a patient with suspected ischaemic heart disease. Significant decreased activity in stress test in LAD supply area, indicating reversible ischaemia. Patient was referred to invasive cardiac unit, resulting in stenting of a 95% narrowing of LAD. ⁸²Rb isotope administered during pharmacological stress and rest. Static recordings for 7 min in both phases. Upper row: pharmacological stress cardiac test. Lower row: rest test. Bulls Eye plots in 17 segments for both stress and rest test. LAD: Left anterior descending artery.

Figure 2

Quantifying blood flow with ⁸²Rb Cardiac PET (Yoshida et al., 1996): pharmacological stress test (adenosine) and rest test of a patient with suspected ischaemic heart disease. Coronary flow reserve significantly decreased in LAD supply area. ⁸²Rb isotope administered during pharmacological stress and rest. Dynamic recordings for 7 min in both phases. Upper row: pharmacological stress cardiac test. Lower row: rest test. LAD, Left anterior descending artery; LCX, Left circumflex artery; RCA, Right coronary artery. Global: global flow in the left ventricle.