The following are key points to remember from a state-of-the-art paper on total-body positron emission tomography (PET) in cardiovascular (CV) research:

1. The recent advent of PET scanners that can image the entire human body has opened up intriguing possibilities for CV research and future clinical applications.
2. These new systems permit radiotracer kinetics to be measured in all organs simultaneously. They are particularly well suited to study CV disease and its effects on the entire body.
3. They could also play a role in quantitatively measuring physiologic, metabolic, and immunologic responses in healthy individuals to a variety of stressors and lifestyle interventions, and may ultimately be instrumental for evaluating novel therapeutic agents and their molecular effects across different tissues.
4. PET has the unique potential to noninvasively measure myocardial blood flow and myocardial flow reserve by dynamic imaging and kinetic modeling of flow tracers such as O-water, ⁸²Rb, ¹³N-ammonia, and ¹⁸F-flurpiridaz.
5. PET radiotracers that target fibroblast activation protein are now being studied with increasing enthusiasm outside their original area of development for oncologic imaging, to interrogate other pathologies associated with progressing fibrosis.
6. Total-body PET may help in linking cardiac fibrosis and heart failure to associated injury of other organs, which is clinically observed by concomitant kidney dysfunction, congestive hepatopathy, and cardiac cachexia.
7. By providing information about the state of a molecular pathway simultaneously for all tissues of the entire body, total-body PET can help in identifying such systems-based interactions and thereby support an approach toward systems-based CV medicine.
8. The full power of machine-learning methods has yet to be unleashed on total-body PET. It is highly likely that by incorporating machine-learning approaches at various points in the imaging chain (detector outputs, data corrections, image reconstruction, kinetic modeling, image analysis), even more information can be extracted from these systems.
9. Of note, one key limitation in the broader dissemination of these advanced PET scanners, namely, their cost, is unlikely to be addressed soon.
10. Finally, total-body PET has the potential to provide robust and reliable analysis of the biology of the heart and vasculature in both health and disease, along with its interplay with other connected systems.

Clinical Topics: Noninvasive Imaging, Computed Tomography, Nuclear Imaging

Keywords: Diagnostic Imaging, Fibrosis, Machine Learning, Positron-Emission Tomography, Whole Body Imaging

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