How to prepare patients for fluorine-18 fluorodeoxyglucose positron emission tomography myocardial viability assessment.

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology Pub Date : 2025-09-02 DOI:10.1016/j.nuclcard.2025.102480

Bruno B Lima, Marvin W Kronenberg, Chloe M Carr, Jessica Duran, Panithaya Chareonthaitawee

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Abstract

Myocardial viability assessment can be valuable in the management of selected patients with moderate-to-severe ischemic cardiomyopathy. Among the viability imaging modalities, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is a key tool for evaluating myocardial metabolic activity, helping to distinguish viable myocardium from scar tissue. Optimal metabolic preparation is crucial to enhance myocardial glucose uptake and ensure accurate imaging, particularly in diabetic patients with variable insulin resistance. This review presents a clinical case illustrating the role of 18F-FDG PET in myocardial viability assessment, explores different metabolic preparation protocols, and examines their clinical implications. The hyperinsulinemic euglycemic clamp (HEC) remains the most effective technique; however,alternative protocols, such as intravenous glucose loading with insulin, are increasingly utilized for their efficiency and practicality. A comparative analysis of these methods provides insight into their suitability for different patient populations. This review also emphasizes the importance of a standardized yet adaptable approach to metabolic preparation,considering individual patient factors and institutional resources. Emerging literature supporting optimized PET imaging protocols is highlighted to help guide clinical decision-making for revascularization in patients with moderate-to-severe ischemic cardiomyopathy.

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如何为18F-FDG PET心肌活力评估患者做准备。

心肌活力评估在中重度缺血性心肌病患者的管理中是有价值的。在存活成像方式中，18f -氟脱氧葡萄糖正电子发射断层扫描（18F-FDG PET）是评估心肌代谢活动的关键工具，有助于区分存活心肌和疤痕组织。最佳的代谢准备对于增强心肌葡萄糖摄取和确保准确成像至关重要，特别是在可变胰岛素抵抗的糖尿病患者中。本文介绍了一个临床病例，说明了18F-FDG PET在心肌活力评估中的作用，探讨了不同的代谢制备方案，并检查了它们的临床意义。高胰岛素-正糖钳夹（HEC）仍然是最有效的技术；然而，替代方案，如静脉葡萄糖负荷胰岛素，越来越多地利用其效率和实用性。这些方法的比较分析提供了洞察他们适合不同的患者群体。本综述还强调了标准化但适应性强的代谢准备方法的重要性，考虑到个体患者因素和机构资源。支持优化PET成像方案的新兴文献被强调，以帮助指导中重度缺血性心肌病患者血运重建的临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Nuclear Cardiology 医学-核医学

CiteScore

5.30

自引率

20.80%

发文量

249

审稿时长

4-8 weeks

期刊介绍： Journal of Nuclear Cardiology is the only journal in the world devoted to this dynamic and growing subspecialty. Physicians and technologists value the Journal not only for its peer-reviewed articles, but also for its timely discussions about the current and future role of nuclear cardiology. Original articles address all aspects of nuclear cardiology, including interpretation, diagnosis, imaging equipment, and use of radiopharmaceuticals. As the official publication of the American Society of Nuclear Cardiology, the Journal also brings readers the latest information emerging from the Society''s task forces and publishes guidelines and position papers as they are adopted.