Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Absolute Quantitation of Myocardial Blood Flow (AQMBF), Positron Emission Tomography (PET), Rest and Pharmacologic Stress
Summary
Absolute Quantitation of Myocardial Blood Flow (AQMBF) using Positron Emission Tomography (PET) is a diagnostic scan that measures the blood flow to heart muscle (myocardium) at rest and under pharmacologic stress. This procedure is often performed as an adjunct to primary PET imaging to provide additional quantitative data on myocardial perfusion.
Purpose
This procedure helps evaluate the health and function of the heart's blood vessels. It can detect areas of reduced blood flow and assess the effectiveness of treatments for coronary artery disease. The primary goal is to improve diagnosis, guide therapy options, and monitor disease progression or treatment outcomes.
Indications
- Symptoms of chest pain or angina
- Suspected coronary artery disease (CAD)
- Evaluation of myocardial ischemia
- Post-intervention assessment (e.g., after stenting or bypass surgery)
- Risk stratification in patients with known heart disease
Preparation
- Patients may be required to fast for several hours before the procedure.
- Certain medications might need to be adjusted or withheld as per doctor's instructions.
- Diagnostic tests such as electrocardiograms (ECG) or previous imaging studies may be reviewed.
Procedure Description
Resting Imaging:
- A small amount of radioactive tracer is injected into a vein.
- The patient lies still under the PET scanner as images are taken to measure resting blood flow.
Pharmacologic Stress:
- A medication (such as adenosine, dipyridamole, or regadenoson) is administered to dilate the blood vessels, mimicking exercise.
- Another set of images is taken to measure blood flow during the stress phase.
Data Analysis:
- The acquired images are analyzed to quantify blood flow in milliliters per minute per gram of myocardial tissue.
The procedure uses advanced PET imaging technology and does not typically require anesthesia or sedation.
Duration
The entire procedure, including preparation and imaging, typically takes about 60 to 90 minutes.
Setting
The procedure is performed in a hospital or outpatient imaging center equipped with PET imaging technology.
Personnel
- Nuclear medicine physician or cardiologist
- Radiologic technologists
- Nurse or clinical staff (administration of pharmacologic agent)
Risks and Complications
- Common: Mild discomfort from the IV placement, mild side effects from the pharmacologic agent (e.g., flushing, headache, nausea)
- Rare: Allergic reactions to the tracer or stress agent, serious arrhythmias, low blood pressure
Benefits
- Accurate measurement of myocardial blood flow.
- Improved assessment of the severity and extent of coronary artery disease.
- Non-invasive evaluation and monitoring.
- Results are typically available within a few days, with immediate preliminary interpretation in some cases.
Recovery
- Most patients can resume normal activities immediately.
- Drink plenty of fluids to help flush the radioactive tracer from the body.
- Follow any specific instructions given by the healthcare provider regarding activity or medications.
- A follow-up appointment may be scheduled to discuss results.
Alternatives
- Exercise stress test
- Single photon emission computed tomography (SPECT) scan
- Cardiac MRI with stress testing
- Coronary angiography
Each alternative has its pros and cons; for example, exercise stress tests are simpler but less detailed, while coronary angiography is more invasive but provides direct visualization of the arteries.
Patient Experience
During the procedure, patients might feel a cold sensation from the tracer injection and possible mild side effects from the pharmacologic agent. After the procedure, patients typically feel normal and can go about their day. Pain management is not usually necessary, but comfort measures are provided as needed.