Direct Imaging of Myocardial Ischemia With ¹⁸FDG: A New Potentially Paradigm-Shifting Molecular Cardiovascular Imaging Technique

Myocardial perfusion imaging has been in extensive clinical use for well over 30 years. This technique is used for diagnosing, risk stratification, and long-term follow-up of patients with suspected or known coronary artery disease (CAD). A unique strength of nuclear imaging is its ability to provide a repertoire of tools for imaging metabolic and biochemical processes and receptor and transporter functions at molecular and cellular levels in intact organisms, under a wide variety of physiological conditions. Despite their high resolution and technical sophistication, other imaging modalities do not have this capability. Metabolic imaging techniques using radiolabeled free fatty acid and glucose analogues provide a unique ability to image myocardial ischemia directly in patients with known or suspected CAD. These techniques can overcome many of the limitations of currently used stress-rest perfusion imaging. In this article, we describe recent studies using ¹⁸FDG for imaging myocardial ischemia.