Cardiac PET: Metabolic and Functional Imaging of the Myocardium Brian Mc Ardle, MB, BCh, Taylor F. Dowsley, MD, Myra S. Cocker, PhD, Hiroshi Ohira, MD, Robert A. deKemp, PhD, Jean DaSilva, PhD, Terrance D. Ruddy, MD, Benjamin J. Chow, MD, and Rob S. Beanlands, MD, FRCPC, FACC Cardiac PET has evolved over the past 30 years to gain wider acceptance as a valuable modality for a variety of cardiac conditions. Wider availability of scanners as well as changes in reimbursement policies in more recent years has further increased its use. Moreover, with the emergence of novel radionuclides as well as further advances in scanner technology, the use of cardiac PET can be expected to increase further in both clinical practice and the research arena. PET has demonstrated superior diagnostic accuracy for the diagnosis of coronary artery disease in comparison with single-photon emission tomography while it provides robust prognostic value. The addition of absolute flow quantification increases sensitivity for 3-vessel disease as well as providing incremental functional and prognostic information. Metabolic imaging using 18 F-fluorodeoxyglucose can be used to guide revascularization in the setting of heart failure and also to detect active inflammation in conditions such as cardiac sarcoidosis and within atherosclerotic plaque, improving our understanding of the processes that underlie these conditions. However, although the pace of new developments is rapid, there remains a gap in evidence for many of these advances and further studies are required. Semin Nucl Med 43:434-448 C 2013 Elsevier Inc. All rights reserved. C ardiac PET is a continually evolving field that enables imaging of multiple aspects of the heart and vasculature, providing diagnostic and prognostic information for a broad range of cardiac conditions, including coronary artery disease (CAD), ischemic and nonischemic cardiomyopathy as well as inflammatory processes such as cardiac sarcoidosis (CS), myocarditis, aortitis, and cardiac infections. In addition, it provides a window into the pathophysiological processes that underlie the aforementioned conditions at a molecular level, enabling the identi fication of novel targets for treatment in the future. Although it has been over 30 years since it was first pioneered for clinical use, 1, 2 widespread application has been limited owing to the expense and associated lack of availability of this technology. With ever-increasing numbers of PET facilities for oncology, combined with increasing evidence for its clinical utility, use of cardiac PET is also expanding. Moreover, this modality has the potential to provide a window into biological processes within the heart. Therefore, its use in the research arena can be expected to continue to increase in the future as well. In this review, we describe current clinical and research applications of cardiac PET, with a focus on the radiotracers employed in current practice as well as highlighting potential future developments in this field. 434 0001-2998/12/$-see front matter & 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1053/j.semnuclmed.2013.06.001 Disclosures: RSB and RdK are consultants with Jubilant DRAXImage and have received grant funding from a government or industry program (partners: GE Healthcare, Nordion, Lantheus Medical Imaging, DRAXImage). RdK receives revenues from a rubidium-82 generator technology licensed to Jubilant DRAXImage, and from sales of FlowQuant. RSB is a consultant for Lantheus Medical Imaging. Funding sources: R.S.B is a career investigator supported by the Heart and Stroke Foundation of Ontario (HSFO) and Tier 1 Research Chair supported by the University of Ottawa. B.M. is supported in part by the MFI HSFO Program Grant (#PRG6242) and The University of Ottawa Heart Institute’ s Whit & Heather Tucker Endowed Research Fellowship in Cardiology Award. TD is supported by the Vered Beanlands Endowed Research Fellowship in Cardiology Award. H.O. is supported by MFI HSFO Program Grant (#PRG6242) and IMAGE-HF (CIHR Grant CIF99470); the Department of Medicine, University of Ottawa and Hokkaido Heart Association Grant for Research. M.S.C. is a research fellow supported by the HSFO. National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Address reprint requests to Rob S. Beanlands, MD, FRCPC, FACC, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin St, Room 3409, Ottawa, Canada K1Y 4W7. E-mail: rbeanlands@ottawaheart.ca