Stress perfusion/metabolism imaging: A pilot study for a potential new approach to the diagnosis of coronary disease in women

Background. The diagnosis of coronary artery disease (CAD) in women continu es to be a challenge. F-18 deoxyglucose (FDG) positron emission tomography (PET) has been used for detection of myocardial ischemia at rest, Little ha s been reported about FDG stress imaging. The aim of this pilot study was t o assess stress FDG PET imaging for defining CAD in a group of women referr ed for chest pain. Methods. Stress FDG imaging was performed in 19 women (mean age 59 +/- 10 y ears). All had abnormal stress testing before entering the study. FDG and 2 -methoxy-2-methylpropyl isonitrile were injected at peak stress (treadmill n = 8, dipyridamole n = 11) followed by PET and single photon emission comp uted tomography image acquisitions. Myocardial ischemia was defined by regi ons that demonstrated both a defect on perfusion imaging and increased FDG uptake relative to uptake in normal perfusion zones. Defect/normal zone FDG ratios were also determined. Coronary angiography was performed on all pat ients. Results, Average, or mean, body mass index was high at 29.2 +/- 5 kg/m(2). Nine of 19 patients had significant CAD. Eight of 9 with CAD had FDG-define d ischemia, Nine of the 10 without CAD had negative FDG images (sensitivity 89%, specificity 90%). The average defect/normal zone FDG ratio was greate r in patients with CAD than in those without (2.4 +/- 1.9 vs 0.9 +/- 0.4, P < .05). Conclusions, Regional FDG uptake in areas of perfusion defects,vith stress increased in this group with CAD. These pilot data suggest that stress FDG PET may be diagnostically helpful in obese female patients. This novel appr oach may complement current methods of CAD detection in women and warrants further study.