Dr. O'Donnell and his colleagues found that PET is superior to SPECT in several aspects.

"The power of PET gave us better quality pictures, especially in heavy patients. It also gave us more accurate quantitative scoring," he says. "With patients who also had recent angiograms, we had a better coordination with coronary angiography."


Providers hope that the introduction of specific tracers will soon add to PET's diagnostic arsenal.

"The holy grail right now is to find what's called vulnerable plaque because with most perfusion scans we're looking for narrowing in the arteries," says Dr. O'Donnell. "But heart attacks don't occur where things are narrow, they occur where there's plaque and they're not the same thing. If we can identify the vulnerable plaque, then we can identify those patients who are at a high risk for heart attacks and death and intervene appropriately," he says.

Currently, Positron Corporation is the only manufacturer of stand-alone PET systems. The Attrius is a cardiac PET scanner with cardiac specific imaging software. The system recently won the 2010 North American Molecular Imaging Systems New Product Innovation Award from the prestigious Frost & Sullivan.

A bolster for the technology retired by key imaging manufacturers several years ago is good news for refurbishers. The resale and service markets are experiencing a rise in demand for stand-alone PET systems, a significant change from 2009.

"A lot of PET units were put into parts. I think people just figured they didn't have a real strong asset there," says Joshua Nunez, product manager of PET and PET/CT for Block Imaging International Inc., a sale and service pre-owned imaging systems company. "Not a lot of value was placed on PET systems last year. Then, starting in September, we started to see the market rising."

But there are only so many stand-alone PET systems available today. The dwindling supply of the units is a growing challenge for refurbishers.

"I think eventually they're going to probably be buying PET/CT, maybe the lower slice count PET/CT, just to be able to do cardiac gating," says Nunez. "Eventually, they're just going to run out of supply."

For many providers, the obstacle to shifting myocardial perfusion studies to PET is rooted in availability. Today, about 80 to 90 percent of PET systems are used for oncology. Imaging facilities build up their caseloads so they can operate close to capacity, leaving little to no room for PET to take on MPI.




"It's somewhat higher quality with a PET scanner and the accuracy is undeniably better, but if the machinery costs almost 10 times as much, it's not clear that you can have enough PET scanners around to do all of the MPI imaging that's needed," says Dr. Graham.

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