Clinical Scenarios for the Use of PET MPI in Specific Populations
| Scenario no. | Description | Appropriateness | Score |
| Patients with advanced obesity or with large breasts or dense breast tissue | |||
| Patients with advanced obesity (BMI > 35m2/kg) | |||
| 119 | Symptomatic patients with advanced obesity (BMI > 35 m2/kg) | Appropriate | 9 |
| 120 | Symptomatic patients with advanced obesity (BMI > 35 m2/kg) who have atherosclerosis or nonobstructive CAD as shown by coronary angiography (invasive or noninvasive) | Appropriate | 8 |
| 121 | Symptomatic patients with advanced obesity (BMI > 35 m2/kg) and normal results of coronary angiography (invasive or noninvasive) | Appropriate | 7 |
| 122 | Symptomatic patients with advanced obesity (BMI > 35 m2/kg) and equivocal findings on stress–rest myocardial perfusion SPECT | Appropriate | 9 |
| 123 | Asymptomatic patients with advanced obesity (BMI > 35 m2/kg) who are at high cardiovascular risk when undergoing noncardiac surgery | Appropriate | 7 |
| 124 | Asymptomatic patients with advanced obesity (BMI > 35 m2/kg) who are at intermediate cardiovascular risk when undergoing noncardiac surgery | May be Appropriate | 5 |
| 125 | Asymptomatic patients with advanced obesity (BMI > 35 m2/kg) who are at low cardiovascular risk when undergoing noncardiac surgery | Rarely Appropriate | 2 |
| Women with large breasts or dense breast tissue that causes attenuation artifacts | |||
| 126 | Symptomatic women with large breasts or dense breast tissue | Appropriate | 8 |
| 127 | Symptomatic women with large breasts or dense breast tissue who have atherosclerosis or nonobstructive CAD as shown by angiography (invasive or noninvasive) | Appropriate | 8 |
| 128 | Symptomatic women with large breasts or dense breast tissue and normal results of coronary angiography (invasive or noninvasive) | Appropriate | 7 |
| 129 | Symptomatic women with large breasts or dense breast tissue and normal results of stress–rest myocardial perfusion SPECT | Appropriate | 7 |
| 130 | Symptomatic women with large breasts or dense breast tissue and equivocal findings on stress–rest myocardial perfusion SPECT | Appropriate | 9 |
| 131 | Asymptomatic women with large breasts or dense breast tissue at high risk when undergoing noncardiac surgery | Appropriate | 7 |
| 132 | Asymptomatic women with large breasts or dense breast tissue at intermediate risk when undergoing noncardiac surgery | May be Appropriate | 5 |
| 133 | Asymptomatic women with large breasts or dense breast tissue at low risk when undergoing noncardiac surgery | Rarely Appropriate | 2 |
| Symptomatic young women and young men | |||
| Symptomatic young women (age < 45 y) | |||
| 134 | Symptomatic young women (age < 45 y) with positive or negative results of an exercise ECG stress test or negative results of stress imaging testing with SPECT or echocardiography, but persistent chest pain syndrome | Appropriate | 8 |
| 135 | Symptomatic young women (age < 45 y) with positive or negative results of an exercise ECG stress test, who have atherosclerosis or nonobstructive CAD as shown by angiography, but persistent chest pain syndrome | Appropriate | 8 |
| 136 | Symptomatic young women (age < 45 y) with positive or negative results of an exercise ECG stress test and normal results of coronary angiography, but persistent chest pain syndrome | Appropriate | 7 |
| 137 | Symptomatic young women with positive or negative results of an exercise ECG stress test and normal SPECT perfusion findings, but persistent chest pain syndrome | Appropriate | 7 |
| Symptomatic young men (age < 40 y) | |||
| 138 | Symptomatic young men (age < 40 y) with negative results of stress–rest imaging testing with SPECT or echocardiography, but persistent chest pain syndrome | Appropriate | 8 |
| 139 | Symptomatic young men (age < 40 y) with positive or negative results of an exercise ECG stress test, who have atherosclerosis, nonobstructive CAD, and persistent chest pain syndrome | Appropriate | 8 |
| 140 | Symptomatic young men (age < 40 y) with positive or negative results of an exercise ECG stress test and normal results on a coronary angiogram, but persistent chest pain syndrome | Appropriate | 7 |
| Children and adolescents with congenital heart disease | |||
| 141 | In children and adolescents with congenital heart disease that could compromise the blood flow supply to the heart, exercise echocardiography, because of the absence of any radiation exposure, should be given preference. If exercise echocardiography is not feasible, then exercise and rest perfusion SPECT is an option. If the patient cannot exercise or the congenital heart disease may compromise the blood flow supply independent of exercise stress, then stress-only or stress–rest perfusion PET is a viable option because of its low radiation exposure. | Appropriate | 8 |
| Patients with familial hypercholesterolemia | |||
| 142 | Symptomatic individuals with familial hypercholesterolemia with negative stress–rest imaging findings, but persistent chest pain syndrome | Appropriate | 7 |
| 143 | Symptomatic individuals with familial hypercholesterolemia with positive or negative results of an exercise ECG stress test, who have atherosclerosis and nonobstructive CAD, but persistent chest pain | Appropriate | 8 |
| 144 | Symptomatic individuals with familial hypercholesterolemia with positive or negative results of an exercise ECG stress test and normal results on a coronary angiogram, but persistent chest pain | Appropriate | 7 |
| 145 | Symptomatic individuals with familial hypercholesterolemia with positive or negative results of an exercise ECG stress test who have no coronary artery calcifications on noncontrast CCT | Appropriate | 7 |
| 146 | Symptomatic individuals with familial hypercholesterolemia and positive or negative results of an exercise ECG stress test who have coronary artery calcifications on noncontrast CCT | Appropriate | 8 |
| 147 | Asymptomatic individuals with familial hypercholesterolemia with positive or negative results of an exercise ECG stress test | Rarely Appropriate | 2 |
| Symptomatic patients with CAD with known left main or multivessel disease | |||
| 148 | Symptomatic patients with known left main or multivessel disease as shown by ICA | Appropriate | 9 |
| 149 | Symptomatic patients with CAD in the left main segment or in all 3 vessels as shown by noninvasive CTA | Appropriate | 9 |
| 150 | Symptomatic patients with coronary artery calcifications in the left main segment or in all 3 vessels as shown by noncontrast CCT | Appropriate | 9 |
| Asymptomatic patients with CAD with known left main or multivessel disease | |||
| 151 | Asymptomatic patients with known left main or multivessel disease as shown by coronary angiography | May be Appropriate | 6 |
| 152 | Asymptomatic patients with pronounced coronary calcifications in the left main or in all 3 main vessels as shown by noncontrast CCT | Appropriate | 7 |
| 153 | Asymptomatic patients with mild coronary calcifications in the left main or in all 3 main vessels as shown by noncontrast CCT | Rarely Appropriate | 3 |
| Patients who have undergone CABG | |||
| 154 | Symptomatic patients after undergoing CABG: stress–rest perfusion PET if exercise SPECT cannot be performed | Appropriate | 8 |
| 155 | Symptomatic patients after undergoing CABG: stress–rest perfusion PET if exercise SPECT is equivocal | Appropriate | 9 |
| 156 | Asymptomatic patients within 5 y of undergoing CABG | Rarely Appropriate | 2 |
| 157 | Asymptomatic patients ≥ 5 y after undergoing CABG | May be Appropriate | 6 |
| Patients who have undergone PCI in multivessel disease | |||
| 158 | Symptomatic patients with known multivessel disease who have undergone PCI, in whom exercise SPECT cannot be performed | Appropriate | 8 |
| 159 | Symptomatic patients with known multivessel disease who have undergone PCI and who have equivocal exercise SPECT results | Appropriate | 9 |
| 160 | Asymptomatic patients within 2 y of undergoing PCI, in whom the diagnostic yield of stress–rest perfusion PET would be low or nonexistent | Rarely Appropriate | 2 |
| 161 | Asymptomatic patients ≥ 2 y after undergoing PCI | May be Appropriate | 6 |
| Use of rest or stress–rest perfusion in patients in conjunction with 18F-FDG PET to assess cardiac sarcoidosis | |||
| 162 | Patients with suspected cardiac sarcoidosis: rest perfusion PET as an integral part of the 18F-FDG PET protocol in the detection and characterization of cardiac sarcoidosis | Appropriate | 8 |
| 163 | Patients with suspected cardiac sarcoidosis and concurrent chest pain symptoms or dyspnea, who are undergoing rest perfusion and the 18F-FDG PET protocol: addition of stress perfusion PET | Appropriate | 8 |
| Use of rest or stress–rest perfusion in patients in conjunction with 18F-FDG PET to assess myocardial viability | |||
| 164 | Patients with assessment of myocardial viability in ischemic cardiomyopathy: rest or stress perfusion PET as an integral part of the 18F-FDG PET protocol in the detection and characterization of myocardial viability | Appropriate | 9 |
| Symptomatic patients who are apparent nonresponders to pharmacologic vasodilation with a need to change to dobutamine stress testing | |||
| 165 | Symptomatic patients with an intermediate probability of CAD who are undergoing functional testing with myocardial perfusion SPECT or PET during pharmacologic stimulation and rest: repeat imaging test with PET but with dobutamine stimulation if there is no hemodynamic response (change in arterial blood pressure or no heart rate increase) during pharmacologic vasodilator stress | Rarely Appropriate | 3 |
| Symptomatic patients with transplant vasculopathy | |||
| 166 | Symptomatic patients or patients with suspected cardiac graft rejection | Appropriate | 8 |
| Symptomatic patients with vasculitis and arteritis (Kawasaki and Takayasu disease) | |||
| 167 | Symptomatic patients with suspected vasculitis and arteritis | Appropriate | 8 |