[Indications for clinical applications of positron emission tomography in cardiology. Position report of the PET Cardiology Study Group of the German Society of Nuclear Medicine and the Nuclear Cardiology Study Circle of the German Society of Cardiology].

Positron emission tomography (PET) represents the most advanced scintigraphic technique which allows accurate qualitative and quantitative assessment of regional myocardial tracer distribution. Besides its well documented potential as a research tool, PET has gained increasing clinical acceptance in cardiology. At the current time, the two most important clinical indications are the detection of coronary artery disease using perfusion traces and the evaluation of patients with advanced coronary artery disease and impaired left ventricular function for identification of tissue viability using metabolic tracers. Direct comparison of PET and SPECT imaging has shown improved diagnostic accuracy of PET imaging for detection of CAD. However, the high cost and limited availability of this technique limit its widespread application as routine method for detection of CAD. Nevertheless, for determination of the functional significance of regional stenoses, PET is the most accurate non-invasive method available. Numerous studies using PET FDG-imaging have demonstrated the high diagnostic accuracy of metabolic imaging for the detection of tissue viability. Recovery of function following revascularization can be predicted with high positive and negative predictive value. Based on its documented diagnostic performance, PET is recommended for assessment of tissue viability especially in patients with severely impaired left ventricular function who are candidates for revascularization or cardiac transplantation. Promising new advances in imaging technology may reduce the costs of PET instrumentation and, therefore, widen the clinical application of this technique.