Cardiac PET
Cardiac PET Cases
Perfusion, viability, sarcoidosis, and amyloidosis. Cases organized by clinical indication. Review the images, then reveal diagnosis and teaching points.
Myocardial PerfusionCardiac SarcoidosisCardiac AmyloidosisViabilityNormal Variants
PET myocardial perfusion imaging with Rb-82, N-13 ammonia, or F-18 flurpiridaz offers superior resolution and quantitative blood flow compared to SPECT. Cases cover ischemia, infarct, and flow reserve.
Cases Coming Soon
Fixed vs Reversible Defect
Infarct vs ischemiaStress and restRb-82Myocardial flow reserve
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Myocardial Flow Reserve
Quantitative PETMicrovascular diseaseBalanced ischemiaRisk stratification
FDG PET combined with perfusion imaging is the standard approach for diagnosing and monitoring cardiac sarcoidosis. Patient preparation to suppress physiologic myocardial uptake is critical.
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Active Cardiac Sarcoidosis
FDG/perfusion mismatchPatient prep protocolHigh-fat low-carb dietTreatment response
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Monitoring on Steroids
Response assessmentResidual activityScar vs activeSteroid taper guidance
Pyrophosphate (PYP) scintigraphy is the primary nuclear medicine tool for ATTR amyloidosis, though PET-based amyloid tracers have a growing role. Cases cover the Perugini grading system and clinical decision points.
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ATTR Cardiac Amyloidosis
Perugini grade 2-3H/CL ratioSPECT vs planarAL vs ATTR
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Negative PYP — AL Amyloid
Perugini grade 0-1AL amyloidosisBiopsy indicationBlood pool subtraction
FDG PET viability assessment identifies hibernating myocardium that may recover function after revascularization. The perfusion-metabolism mismatch pattern is the key finding.
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Perfusion-Metabolism Mismatch
Hibernating myocardiumFDG uptake preservedRevascularization candidateLVEF recovery
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Matched Defect — Scar
Concordant reductionNon-viableNo benefit from revascManagement implications
Physiologic myocardial FDG uptake is the most common pitfall in cardiac PET. Recognizing patterns of incomplete suppression, attenuation artifacts, and motion is essential.
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Incomplete Myocardial Suppression
Inadequate prepFocal vs diffuse uptakeRepeat imagingHeparin protocol
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Attenuation Artifacts
Diaphragmatic attenuationBreast attenuationMotion mismatchAC vs non-AC