Positron emission tomography in coronary artery disease

PURPOSE OF REVIEW: Mortality and coronary events are dramatically reduced in coronary artery disease by intense lifestyle and pharmacologic management without further improvement by revascularization procedures, thereby requiring definitive noninvasive diagnostic imaging. Consequently, this review summarizes the evidence supporting cardiac positron emission tomography as a definitive, noninvasive, 'one-stop' test for routine management of coronary artery disease that is well validated in the scientific literature and illustrated by clinical cases. RECENT FINDINGS: Substantial evidence documents accuracy of positron emission tomography for identifying early or advanced coronary artery disease, quantifying its severity, risk stratification, deciding on revascularization procedures, following progression or regression and for evaluating coronary endothelial function as the basis for preventive treatment. Recent technology like positron emission tomography-computed tomography, however, requires advanced knowledge, training and attention to technical details to avoid common artifactual results and to provide definitive conclusions illustrated in this review. SUMMARY: Cardiac positron emission tomography, done correctly with attention to technical details, provides definitive noninvasive assessment of early or advanced coronary atherosclerosis as the basis for invasive procedures or for lifelong intense risk factor management, demonstrates progression or regression of disease, predicts clinical outcomes and serves as the primary definitive noninvasive guide for managing coronary artery disease.