Cardiovascular Business - January/February 2008 - (Page 14)

CaRDIaC PeT/CT fIlls In GaPs lefT BY sPeCT “the use of pEt to provide a measure of absolute blood flow will move from the research realm into routine clinical practice.” — Daniel Berman, MD, Cedars-sinai Medical Center Similarly, in the future, cardiologists may turn to highresolution PET/CT scanners to characterize activity associated with coronary artery disease and vascular disease. Current imaging techniques limit cardiologists to a static anatomic image of stenosis; however, we know that a 50 percent blockage filled with inflammatory cells may be more likely to rupture and lead to a heart attack than a 70 to 80 percent stable stenosis. The hitch is identifying inflammatory activity of coronary plaque. PET provides a tool to image glucose activity, which may identify rupture-prone plaque. Currently, researchers at Cedars-Sinai Medical Center and Massachusetts General Hospital are undertaking a research project that uses PET/CT to analyze the degree of inflammatory activity and consequent risk for a coronary event. Right now, rubidium-82 is the primary isotope used in cardiac PET/CT; however it isn’t ideal, particularly in terms of its resolution characteristics. One current research focus is fluorine-labeled tracers. A fluorine-labeled agent currently in Phase 1 development provides several advantages. It offers improved uptake characteristics in terms of its properties and flow. The fluorine-labeled agent provides a linear uptake relationship and remains in the heart longer than rubidium-82, so it offers flexibility by uncoupling the tracer injection and the scan. This will allow the performance of exercise PET scans currently not feasible with rubidium-82. The fluorine-labeled compound also could open the cardiac PET/CT market to smaller centers that might not have the volume to justify a dedicated cardiac PET/CT camera. Because it offers some flexibility in terms of time, such sites could slip a cardiac case among the oncologic PET/CT caseload. A there’s a great deal of research in the clinical realm. what about on the tracer front? Can we expect to see new tracers for cardiac Pet/Ct? 82 Q rb stress and rest study showed infero-lateral wall ischemia at stress with normalization of perfusion at rest, suggesting reversible left circumflex territory ischemia. (image courtesy of Emory Crawford Long) Hospitals across the country are expressing increasing interest in cardiac Pet/Ct. Can you offer any advice in terms of implementing a solution? Clearly, the first step is raising the funds to purchase the scanner. For large sites, cardiac PET/CT can be cost-effective because it offers a shorter imaging time than cardiac SPECT. Sites can increase patient throughput with only a slight increase in staff and may be able to increase utilization of their PET/CT scanner. It’s my understanding that cardiac PET/CT becomes cost-effective with a minimum of four patients a day; our system easily accommodates more than double the four patient threshold. It’s important to remember that PET/CT requires a larger room than cardiac SPECT. In fact, the space requirement is double that of a nuclear cardiology suite. The other element is staff training. Nuclear cardiologists require training in terms of interpretation, and technologists need to be licensed in both nuclear and CT modalities. this article first appeared in the January 2008 issue of Molecular imaging insight. Q A 14 Cardiovascular Business January/february 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2008

Cardiovascular Business - January/February 2008 Contents The Ticker: Quality Pays in Several Ways Cover Story: The Proof: Why Evidence-based Medicine Improves Cardiac Care Clinical Study Digest: Co-payments and Cath Labs Cardiac PET/CT Fills in Gaps Left by SPECT Tapping into IT to Improve the Office-Based Practice SPECT–Proving Its Value Cardiac Images in the EMR: Just a Click Away The Top 20 Ways to Market Your Cardiac CTA Practice The Big Picture: Medical Displays for Cardiac Images Statins Work But Pharmacoeconomic Caveats Abound Driving Data Protection: Opting for Storage On- or Offsite News & Views Calendar Reader’s Resource

Cardiovascular Business - January/February 2008

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