Myocardial perfusion imaging with 15O-water positron emission tomography (PET) is a validated tool for quantitative measurement of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Current scanner and software technology enable quantification of global and regional MBF in clinical PET myocardial perfusion imaging studies. Reduced stress MBF or MFR measured by 15O-water PET accurately detects hemodynamically significant coronary artery stenosis defined by intracoronary fractional flow reserve (FFR) measurement in patients with suspected obstructive coronary artery disease (CAD). Furthermore, MBF and MFR provide prognostic information on mortality and risk of myocardial infarction. Clinical experience in some centers indicates that clinical application of 15O-water PET in evaluation of CAD is feasible and guides management decisions on revascularization. This review discusses basic concepts of measuring MBF with 15O-water PET and reviews clinical studies on its application in evaluation of obstructive CAD.
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