Positron emission tomography and interventional cardiology. Current noninvasive diagnostic techniques have limited accuracy for detection of coronary artery disease (CAD) in symptomatic and (particularly) asymptomatic patients with silent disease. Furthermore, no standard noninvasive method provides reliable diagnostic information on the location of the coronary arteries involved, the severity of stenosis, the presence of collaterals and myocardial viability. Based on greater than 1,000 cardiac studies at the University of Texas, cardiac positron emission tomography (PET) with either generator-produced rubidium-82, cyclotron-produced N-13 ammonia, or F-18 deoxyglucose is suitable for 4 routine diagnostic purposes: (1) noninvasive diagnosis of CAD in either symptomatic or asymptomatic subjects with a sensitivity of 95 to 98% and specificity of 95 to 100%. This accuracy is now sufficient to schedule diagnostic catheterization and multivessel angioplasty with surgical backup on the basis of the PET scan. At the University of Texas we carry out PET in asymptomatic and symptomatic patients to direct those with mild disease to cholesterol-lowering reversal therapy and those with severe disease to percutaneous transluminal coronary angioplasty (PTCA); (2) assessment of physiologic severity of coronary artery stenosis as compared to automated quantitative coronary arteriographic analysis. Changes in stenosis severity are followed before and after interventions including PTCA, bypass surgery, vasodilator drugs and cholesterol control regimens for reversal of coronary atherosclerosis; (3) imaging myocardial infarction, ischemia, viability, zone at risk and sizing of these pathophysiologic processes. 