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Cardiology Indications for PET Scans

The following cardiology indications are funded for PET scanning in Ontario based on the eligibility criteria listed.

For patients who may benefit from a PET scan, but do not meet the eligibility criteria to receive a PET scan for one of the listed indications, referring physicians may wish to apply for a PET scan for their patient by filling out the Special Access Request portion of the Cardiac FDG PET Requisition Form (see sidebar). 

Myocardial Viability Assessment

(See sidebar for referral form.)

Indication: PET for myocardial viability assessment

Eligibility criteria

Patient is suitable for a cardiac revascularization procedure or cardiac transplantation with moderate to severe ischemic left ventricular dysfunction (left ventricular ejection fraction of 40% or less) despite maximal therapy.

AND

Patient has had a prior myocardial viability or stress imaging assessment with another modality (i.e., SPECT using thallium, MIBI or dobutamine stress echocardiography) that has been equivocal for viability or demonstrated insufficient viable myocardium OR has severe ischemic left ventricular dysfunction and known multi-vessel coronary disease (determined by coronary angiography) and urgently requires an assessment of myocardial viability.

Cardiac Sarcoidosis

(See sidebar for referral form.)

Indication: PET for the diagnosis and clinical management of patients with suspected or diagnosed cardiac sarcoidosis

Eligibility criteria 

Patient has biopsy-proven or clinical diagnosis of pulmonary or systemic sarcoidosis

AND

Obstructive coronary disease has been ruled out

  • Supporting documents must include a positive biopsy or clinical consult demonstrating pulmonary or systemic sarcoid AND one or more abnormal initial screening tests to screen for cardiac involvement. An abnormal screening test is defined as one or more of the following:
    • Abnormal ECG defined as complete left or right bundle branch block and/or presence of unexplained pathological Q waves in 2 or more leads
    • Abnormal echo defined as RWMA and/or wall aneurysm and/or basal septum thinning and/or LVEF < 50%
    • Abnormal Holter defined as sustained or non-sustained VT
    • Cardiac MRI suggestive of cardiac sarcoid

Young patients with unexplained new onset conduction system disease

  • Defined as sustained Mobitz II 2nd degree or 3rd degree AV block

Patients with idiopathic sustained ventricular arrhythmias, to screen for CS as underlying etiology

“Idiopathic VT” is defined as VT not fulfilling any of following criteria:

  • Typical outflow tract VT
  • Fascicular VT
  • VT secondary to other structural heart disease (coronary artery disease, any cardiomyopathy other than idiopathic)

Surveillance of patients with proven cardiac sarcoid to follow response to treatment with steroids and/or immunosuppressants.

  • Patients undergoing 3 or more FDG PET scans to assess response to therapy will have PET scan series reviewed by expert PET reviewer and Cardiac Sarcoid Specialist.

Cardiomyopathy & Ventricular Arrhythmia

(See sidebar for referral form.)

Indication: PET for the diagnosis and clinical management of patients with unexplained cardiomyopathy and associated ventricular tachycardia or fibrillation

Eligibility criteria

Ventricular arrhythmia in the setting of unexplained cardiomyopathy, despite adequate investigation, including referral/consultation with an EP (electrophysiology) specialist

Device Infections

(See sidebar for referral form.)

Indication: PET for the diagnosis and clinical management of patients with suspected infection of pacemaker, ICD, CRT where there is a high clinical suspicion and/or laboratory evidence of infection

Eligibility criteria

  • Suspected generator or pocket infection without endovascular lead infection
  • Suspected endovascular lead infection without generator pocket infection
  • Suspected generator pocket infection and endovascular lead infection
  • Suspected extra-cardiac complications (i.e., septic emboli)

Infective Endocarditis

(See sidebar for referral form.)

Indication: PET for the diagnosis and clinical management of patients where, using modified Duke criteria there is a high clinical suspicion and/or laboratory evidence of infection.

Eligibility criteria

  • Possible infective endocarditis
  • Rejected infective endocarditis (according to modified Duke Criteria), but clinical suspicion is high
  • Definite infective endocarditis with:
    • Suspicion of extra-cardiac complications (i.e. septic emboli)
    • Suspicion of cardiac complications (e.g. perivalvular abscess)

Inflammation/Myocarditis

(See sidebar for referral form.)

Indication: PET for the diagnosis and clinical management of patients where there is a high clinical suspicion and/or laboratory evidence of myocarditis

Eligibility criteria

  • Recurrent myocarditis/symptoms despite adequate treatment of the initial episode
  • Lack of left ventricular function recovery
    • Troponin elevation out of keeping with the diagnosis of myocarditis

Pericarditis

(See sidebar for referral form.)

Indication: PET for the diagnosis and clinical management of patients where there is a high clinical suspicion or lab evidence of pericarditis

  • Persistent symptoms despite 2 weeks of adequate therapy
  • Recurrent pericarditis/symptoms despite adequate treatment of the initial episode
  • Assess response to therapy 4 weeks after therapy initiation

Vasculitis/Aortitis

(See sidebar for referral form.)

Indication: PET for the diagnosis and determination of clinical management of patients where there is a high clinical suspicion and/or laboratory evidence of vasculitis/aortitis

Eligibility criteria

  • Evaluate suspected vasculitis to determine extent and distribution of disease activity
  • To monitor effects of therapy where conventional investigations are equivocal or insufficient
  • Where treatment would be altered if ongoing inflammatory disease is confirmed or ruled out

Other Inflammatory Processes

(See sidebar for referral form.)

Compelling evidence may be submitted via the Cardiac PET Special Access Program. 

Eligibility criteria

Suspicion of cardiac inflammatory processes (i.e., multiple differential inflammatory diagnoses based on MRI/CT imaging)

Myocardial Perfusion (Rb-PET)

Eligibility criteria

  • Stress PET for the assessment of patients with known or suspected coronary artery disease (CAD) with an intermediate (10% to 90%) pre-test likelihood of significant ischemia secondary to coronary stenosis where:
  • there is a high likelihood of attenuation artifact with SPECT imaging OR
  • a high degree of functional accuracy or quantitative flow measurements is required OR
  • functional imaging is required and a low radiation dose is preferable (such as younger patients) OR
  • the results of prior non-invasive imaging are equivocal or inconclusive OR
  • in patients with known CAD where the need for intervention is uncertain

 

  • Quantitative PET flow imaging may be particularly helpful when there is a need for absolute MBF measurements, such as:
  • patients without known CAD who present with symptoms suspect for ischemia
  • patients with known CAD,where specific physiological assessment is desired
  • identifying patients with an increased suspicion for multivessel CAD
  • to assess possible microvascular dysfunction
  • heart transplant patients when there is a question of vasculopathy

 

Locations

Current locations for PET scans for this indication
PET CENTRE LOCATION PHONE NUMBER STATUS
University of Ottawa Heart Institute 613-696-7000 ext. 14809 Active
St. Joseph’s Health Care in Hamilton 905-522-1155 ext. 32746 Active
University Health Network n/a Coming soon