Mount Sinai Morningside recently installed a new rubidium generator to facilitate a reliable source of isotopes for cardiac positron emission tomography (PET) studies.
With this update, Mount Sinai will become the leading health system in New York City offering high-quality, timely, and easy access to the entire range of advanced cardiac PET imaging. Cardiac PET testing includes three common type of studies: cardiac stress imaging with PET; cardiac PET viability imaging; and cardiac PET infection and inflammation imaging.
Cardiac stress PET myocardial perfusion imaging is the most accurate non-invasive test to diagnose obstructive coronary artery disease as well as coronary microvascular dysfunction, which is a common cause of symptoms and morbidity among patients who have ischemia with non-obstructive coronary arteries (INOCA) with continued symptoms.
Other key advantages of cardiac PET include:
- Significantly lower radiation dose to the patient—approximately 3 mSV, or millisieverts, a unit of radiation exposure, per study, equal to about the amount of radiation a person is exposed to from natural sources over the course of a year.
- Superior imaging technology leading to excellent image quality even among patients with unfavorable bodily characteristics such as obesity or women with large breasts or breast implants.
- Availability of coronary artery calcium score information to detect subclinical atherosclerosis.
- Availability of absolute myocardial blood flow quantitation, which helps to accurately diagnose flow-obstructing CAD including high-risk, multi-vessel CAD, diffuse atherosclerosis, post-heart transplant vasculopathy, and microvascular dysfunction in INOCA.
- Increased efficiency and significantly shorter study time—a rest and stress Rb-82 PET takes about 30 minutes.
Due to these advantages, recent American College of Cardiology and American Heart Association guidelines on chest pain evaluation endorse the preferred use of cardiac PET over other stress imaging modalities.
Common indications for cardiac PET stress testing are:
- Symptomatic patients with suspected ischemia unable to exercise or complete exercise during a treadmill test.
- Previous poor quality stress imaging: equivocal or inconclusive results, artifact on images, patients with discordant results on angiogram and stress study.
- Body characteristics affecting image quality: large breasts, obesity, pleural effusions, chest wall deformities.
- High-risk patients to avoid diagnostic errors: patients with history of chronic kidney disease, diabetes, suspected left main or multi-vessel disease, extensive known CAD, suspected transplant vasculopathy, known CAD prior to high-risk revascularization.
- Young patients with established CAD requiring testing to avoid repeat radiation exposure.
- Situations where myocardial flow quantitation is necessary for clinical decision-making, (e.g. microvascular dysfunction and/or suspected multi-vessel disease).
Cardiac PET viability testing is the gold standard for detecting hibernating myocardium among patients with suspected ischemic cardiomyopathy and heart failure with significant CAD. Cardiac PET guided management has been shown to reduce long-term adverse cardiac events among these patients.
Cardiac infection and inflammation PET imaging is critical for the diagnosis and management of patients with suspected or known cardiac sarcoidosis, suspected prosthetic valve endocarditis, left ventricular assist device (LVAD) infections, pocket, and other cardiac device infections.
To refer a patient for a cardiac PET scan, please contact the Cardiology Department at Mount Sinai Morningside 212-636-4809 or send an email to cardiacPet-scan@mountsinai.org.
Click here for more information on the PET CT program at Mount Sinai Morningside.