Fluorodeoxyglucose-PET in Myocardial Viability and Ischemic Heart Disease.

Assessment of myocardial viability remains pivotal in managing patients with ischemic cardiomyopathy and left ventricular dysfunction. Fluorine-18 fluorodeoxyglucose (FDG)-PET is the reference standard for evaluating myocardial metabolic viability, enabling identification of dysfunctional yet salvageable myocardium that may benefit from revascularization. This review summarizes the pathophysiological basis, imaging protocols, interpretation strategies, and clinical evidence supporting FDG-PET for myocardial viability assessment. Particular emphasis is placed on recent advancements, including quantitative imaging, hybrid PET/computed tomography and PET/MR imaging systems, artificial intelligence, radiomics, and emerging molecular tracers. Future directions and ongoing challenges in viability imaging are also discussed.