Enhancing Diagnostics in Cardiac and Cerebrovascular Disorders: The Role of PET Imaging

PET imaging provides quantitative myocardial blood flow and flow reserve, refining how we understand cardiac–cerebrovascular interactions. The same technology that enhances our view of coronary physiology and perfusion also illuminates systemic vascular health. As shown in the PRIMARY‑HF trial, which linked PET‑derived flow metrics with adverse outcomes, this prognostic lens supports cross‑vascular risk stratification that can shape neurovascular decisions.

Building on this bridge, programs are operationalizing a shared cardio‑neuro pathway: ED stroke evaluation proceeds with CT/CTA ± perfusion while parallel cardiac assessment identifies arrhythmia, ischemia burden, or heart failure that could reshape thrombolysis or thrombectomy risk. PET enters as a planned adjunct—outside the hyperacute window—to quantify flow reserve, refine secondary prevention, and inform anesthesia and blood‑pressure targets for staged interventions.

Innovations in PET scanning, such as motion correction and noise‑aware reconstruction, are driving greater diagnostic precision across both domains. These advances increase image quality and can enable lower administered activity or shorter acquisitions when validated by protocol, rather than intrinsically reducing radiation or making PET the preferred modality on that basis alone.

For time‑sensitive neurovascular care, early imaging guides treatment strategy. Perfusion‑based CT or MR can select candidates for mechanical thrombectomy in extended windows, while concurrent cardiac risk assessment helps tailor periprocedural management; in this context, PET‑derived ischemia burden can inform hemodynamic goals without delaying reperfusion decisions.

Linking preoperative insight to intraoperative action, PET‑identified ischemia or microvascular dysfunction can shape anesthetic and hemodynamic strategy before neurovascular intervention. Continuous monitoring during procedures then sustains that vigilance: real‑time cerebrovascular assessments allow on‑the‑fly adjustments that protect penumbra and perfusion. Intraoperative techniques, highlighted in cutting‑edge perfusion monitoring, show how this continuum translates into tangible gains at the bedside.

These converging workflows also inform secondary prevention. When PET reveals impaired flow reserve, clinicians can escalate anti‑ischemic therapy, align lipid and blood‑pressure targets, and anticipate autonomic fluctuations that influence cerebral perfusion, tightening the feedback loop between cardiac optimization and stroke risk reduction.

Importantly, PET’s role complements rather than competes with neuroimaging. CT and MR perfusion adjudicate tissue viability in minutes; PET, scheduled shortly thereafter or in the subacute phase, contributes a systemic view of perfusion and metabolism that informs rehabilitation thresholds, arrhythmia surveillance, and blood‑pressure titration.

Operationally, technology validation matters. AI‑assisted reconstruction and motion correction should be implemented with protocol‑level testing to ensure quantitative integrity of myocardial blood flow and flow reserve. Where validated, centers can leverage shorter acquisitions or lower activity while preserving accuracy, improving throughput without overstating radiation benefits.

Finally, a shared language across teams sustains the arc: cardiology reports highlight global and regional flow reserve alongside ischemia burden; stroke notes reference these metrics when planning anesthesia and hemodynamic targets for staged carotid or intracranial procedures. This reciprocity closes the loop from prehospital triage to definitive therapy.

Key takeaways

• PET‑quantified myocardial blood flow and flow reserve provide a shared language for linking cardiac ischemia with neurovascular risk.
• Technology advances (motion correction, noise‑aware reconstruction) improve image quality and, when validated by protocol, can enable lower activity or shorter scans without claiming inherent dose reduction.
• Time‑critical stroke pathways rely on early imaging; integrating cardiac risk—supported by PET when available—helps tailor periprocedural strategy without delaying reperfusion.
• A continuous imaging arc from preoperative PET planning to intraoperative perfusion monitoring strengthens decision‑making at each step.