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)
CPT4 code
Name of the Procedure:
Myocardial Imaging, Positron Emission Tomography (PET), Perfusion Study
Common names: PET myocardial perfusion imaging, PET heart scan
Summary
A PET myocardial perfusion study is a type of heart imaging test that shows how well blood is flowing through the heart muscle. It can be done at rest and during stress (exercise or using medication to simulate exercise). This test helps doctors see if there are areas of the heart that are not getting enough blood flow.
Purpose
Medical Condition/Problem: To assess for coronary artery disease (CAD), ischemia, and the overall health of the heart muscle (myocardium).
Goals/Outcomes: Helps diagnose heart conditions, evaluate the severity of known heart disease, and guide treatment decisions. It can show the heart's pumping strength and detect areas with reduced blood flow.
Indications
- Symptoms like chest pain, shortness of breath, or unexplained fatigue.
- Known or suspected coronary artery disease.
- Abnormal results from other tests like an EKG or stress test.
- Assessment before or after a heart procedure or surgery.
- Unexplained decreases in heart function.
Preparation
- Fasting: No food or drink for at least 4-6 hours before the test.
- Medications: Some medications may need to be adjusted or stopped; follow your doctor’s instructions.
- Other Preparations: Avoid caffeine and tobacco for 24 hours before the test. Wear comfortable clothing and shoes suitable for exercising.
Procedure Description
- Injection: A small amount of a radioactive tracer is injected into a vein. It highlights areas of the heart muscle on the PET images.
- Resting Images: Initial images are taken while the patient is at rest using a PET scanner.
- Stress Phase: The patient undergoes physical exercise on a treadmill or stationary bike. If unable to exercise, medication is given to simulate stress.
- Stress Images: Additional images are taken during and after the stress phase.
- Analysis: The images from both sets (rest and stress) are compared to identify any differences in blood flow.
Equipment Used: PET scanner, radioactive tracer
Sedation: Typically not required, but stress phase may require medication.
Duration
Typically takes about 3-4 hours from start to finish, including preparation and scanning time.
Setting
Usually performed in a hospital or specialized imaging center.
Personnel
- Cardiologist or nuclear medicine physician
- Radiologic technologists
- Nurses
- Exercise physiologist or technician (if exercise is part of the test)
Risks and Complications
- Common Risks: Mild discomfort from the injection, slight risk of an allergic reaction to the tracer.
- Rare Risks: Arrhythmia during stress phase, very low risk of radiation exposure-related issues.
Benefits
- Expected Benefits: Accurate diagnosis of coronary artery disease, identification of areas of reduced blood flow, better-informed treatment decisions.
- Realization: Immediate, as results are available soon after the test.
Recovery
- Post-procedure: Most patients can return to normal activities immediately.
- Instructions: Drink plenty of water to help flush the tracer from your system.
- Recovery Time: No significant downtime expected, but some patients may feel tired after the stress phase.
Alternatives
- Other Options: Standard exercise stress test, single-photon emission computed tomography (SPECT), CT angiography, cardiac MRI.
- Pros and Cons: PET provides more detailed and accurate images but is more expensive and involves exposure to radioactive materials.
Patient Experience
- During: May feel slight discomfort from the injection. If exercise is involved, you might feel the usual effects of physical exertion.
- After: Some fatigue is possible. Drink fluids to help eliminate the tracer. Following the stress test, you may need to rest briefly if medication was used.
Pain Management: Generally no pain, mild discomfort managed with standard measures.