Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired compute
CPT4 code
Name of the Procedure:
Myocardial Imaging, Positron Emission Tomography (PET), Perfusion Study (including Ventricular Wall Motion[s] and/or Ejection Fraction[s], when performed); Multiple Studies at Rest and Stress (Exercise or Pharmacologic), with Concurrently Acquired Computed Tomography
Summary
A Myocardial PET perfusion study is a non-invasive imaging test that uses positron emission tomography (PET) to assess the blood flow to the heart muscle at rest and during stress. The procedure helps detect areas of reduced blood flow and evaluates the function of the heart's ventricles, including their movement and ejection fraction.
Purpose
This procedure is used to:
- Diagnose coronary artery disease (CAD).
- Evaluate the severity of CAD.
- Monitor how well the heart is functioning.
- Assess heart muscle viability. The goal is to identify areas of the heart that have poor blood flow and to guide treatment decisions to improve heart function and prevent heart attacks.
Indications
- Chest pain or angina.
- Shortness of breath.
- Abnormal results from other cardiac tests.
- History of heart attack.
- Risk factors for coronary artery disease, such as hypertension, diabetes, high cholesterol, and family history of heart disease.
Preparation
- Fasting for at least 4-6 hours before the procedure.
- Avoiding caffeine and smoking for 24 hours before the test.
- Informing the healthcare provider about all medications being taken; some may need to be adjusted or stopped temporarily.
- Wearing comfortable clothing and shoes if an exercise stress test is planned.
Procedure Description
- Resting Phase: The patient will be injected with a radioactive tracer while at rest. After a waiting period, the patient will lie on a scanning table and a PET camera will acquire images of the heart.
- Stress Phase: The patient will either exercise on a treadmill or receive a pharmacologic agent to simulate stress. Another dose of the tracer is administered, and further imaging is conducted.
- Concurrent CT: A computed tomography (CT) scan is done simultaneously to provide detailed anatomical information.
Tools and Equipment:
- PET scanner.
- CT scanner.
- Radioactive tracers (e.g., Rubidium-82 or Nitrogen-13).
- ECG monitor.
The procedure generally does not require anesthesia, although mild sedation may be used in certain cases if the patient has anxiety or difficulty staying still.
Duration
The entire procedure typically takes about 2-3 hours, including preparation, waiting periods, and imaging.
Setting
The procedure is usually performed in a hospital or specialized outpatient cardiac imaging center equipped with PET/CT scanners.
Personnel
- Cardiologist.
- Nuclear medicine technologist.
- Nurse.
- Possibly a radiologist and a technician.
Risks and Complications
- Exposure to a small amount of radiation.
- Rare allergic reactions to the radioactive tracer.
- Adverse reactions to pharmacologic stress agents, such as flushing, shortness of breath, or chest pain.
- Rarely, complications related to exercise stress such as arrhythmias or heart attack.
Benefits
- High accuracy in detecting coronary artery disease.
- Detailed information on heart function and blood flow.
- Non-invasive with minimal discomfort.
- Results can help guide treatment plans and improve heart health.
Recovery
- Patients can typically resume normal activities immediately after the procedure.
- It is important to stay hydrated to help flush the radioactive tracer out of the body.
- Follow-up appointments may be scheduled to discuss the results and plan further treatment if necessary.
Alternatives
- SPECT myocardial perfusion imaging.
- Cardiac MRI.
- Stress echocardiography.
- Coronary angiography.
Each alternative has its pros and cons in terms of accuracy, availability, and the type of information provided.
Patient Experience
During the procedure, patients might feel a mild prick from the injection and may experience some discomfort from lying still. If an exercise stress test is performed, they might feel fatigue or breathlessness. Pharmacologic stress can cause feelings similar to exercise-induced stress, like rapid heartbeat or flushing. Pain management and comfort measures are readily available if required.