Abstract:!The following overview provides a summary of the state of the art and research as well as potential clinical applications of cardiovascular PET/MR imaging. PET/MRI systems have been clinically available for a few years, and their use in cardiac imaging has been successfully demonstrated. At this period in time, some of the technical difficulties that arose at the beginning have been solved; in particular with respect to MRI-based attenuation correction, caution should be exercised with PET quantification. In … Show more
“…It is axiomatic that knowledge of ventricular mural architecture is essential when assessing the clinical findings now revealed using computed tomography or magnetic resonance imaging [2]. Our current findings should also provide the means of interpreting new imaging modalities currently in development, such as the integration of positron emission tomography and magnetic resonance imaging [29]. It is our hope that they will provide a deeper understanding of the processes underscoring the different disease entities.…”
▼Purpose: There are ongoing arguments as to how cardiomyocytes are aggregated together within the ventricular walls. We used pneumatic distension through the coronary arteries to exaggerate the gaps between the aggregated cardiomyocytes, analyzing the pattern revealed using computed tomography, and validating our findings by histology. Methods: We distended 10 porcine hearts, arresting 4 in diastole by infusion of cardioplegic solutions, and 4 in systole by injection of barium chloride. Mural architecture was revealed by computed tomography, measuring also the angulations of the long chains of cardiomyocytes. We prepared the remaining 2 hearts for histology by perfusion with formaldehyde. Results: Increasing pressures of pneumatic distension elongated the ventricular walls, but produced insignificant changes in mural thickness. The distension exaggerated the spaces between the aggregated cardiomyocytes, compartmenting the walls into epicardial, central, and endocardial regions, with a feathered arrangement of transitions between them. Marked variation was noted in the thicknesses of the parts in the different ventricular segments, with no visible anatomical boundaries between them. Measurements of angulations revealed intruding and extruding populations of cardiomyocytes that deviated from a surface-parallel alignment. Scrolling through the stacks of tomographic images revealed marked spiraling of the aggregated cardiomyocytes when traced from base to apex. Conclusion: Our findings call into question the current assumption that cardiomyocytes are uniformly aggregated together in a tangential fashion. There is marked heterogeneity in the architecture of the different ventricular segments, with the aggregated units never extending in a fully transmural fashion.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
“…It is axiomatic that knowledge of ventricular mural architecture is essential when assessing the clinical findings now revealed using computed tomography or magnetic resonance imaging [2]. Our current findings should also provide the means of interpreting new imaging modalities currently in development, such as the integration of positron emission tomography and magnetic resonance imaging [29]. It is our hope that they will provide a deeper understanding of the processes underscoring the different disease entities.…”
▼Purpose: There are ongoing arguments as to how cardiomyocytes are aggregated together within the ventricular walls. We used pneumatic distension through the coronary arteries to exaggerate the gaps between the aggregated cardiomyocytes, analyzing the pattern revealed using computed tomography, and validating our findings by histology. Methods: We distended 10 porcine hearts, arresting 4 in diastole by infusion of cardioplegic solutions, and 4 in systole by injection of barium chloride. Mural architecture was revealed by computed tomography, measuring also the angulations of the long chains of cardiomyocytes. We prepared the remaining 2 hearts for histology by perfusion with formaldehyde. Results: Increasing pressures of pneumatic distension elongated the ventricular walls, but produced insignificant changes in mural thickness. The distension exaggerated the spaces between the aggregated cardiomyocytes, compartmenting the walls into epicardial, central, and endocardial regions, with a feathered arrangement of transitions between them. Marked variation was noted in the thicknesses of the parts in the different ventricular segments, with no visible anatomical boundaries between them. Measurements of angulations revealed intruding and extruding populations of cardiomyocytes that deviated from a surface-parallel alignment. Scrolling through the stacks of tomographic images revealed marked spiraling of the aggregated cardiomyocytes when traced from base to apex. Conclusion: Our findings call into question the current assumption that cardiomyocytes are uniformly aggregated together in a tangential fashion. There is marked heterogeneity in the architecture of the different ventricular segments, with the aggregated units never extending in a fully transmural fashion.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
“…PET and MRI can also be used for assessment of the response to medical treatment. However, other than short case reports, there is still lack of published reports on use of PET/MR in identification and follow-up of patients with myocarditis [ 27 ]. Fig.…”
The cardiovascular system is affected by a wide range of pathological processes, including neoplastic, inflammatory, ischemic, and congenital aetiology. Magnetic resonance imaging (MRI) and positron emission tomography (PET) are state-of-the-art imaging modalities used in the evaluation of these cardiovascular disorders. MRI has good spatial and temporal resolutions, tissue characterization and multi-planar imaging/reconstruction capabilities, which makes it useful in the evaluation of cardiac morphology, ventricular and valvar function, disease characterization, and evaluation of myocardial viability. FDG-PET provides valuable information on the metabolic activity of the cardiovascular diseases, including ischemia, inflammation, and neoplasm. MRI and FDG-PET can provide complementary information on the evaluation of several cardiovascular disorders. For example, in cardiac masses, FDG-PET provides the metabolic information for indeterminate cardiac masses. MRI can be used for localizing and characterizing abnormal hypermetabolic foci identified incidentally on PET scan and also for local staging. A recent advance in imaging technology has been the development of integrated PET/MRI systems that utilize the advantages of PET and MRI in a single examination. The goal of this manuscript is to provide a comprehensive review on the incremental value of PET and MRI in the evaluation of cardiovascular diseases.Main Messages• MRI has good spatial and temporal resolutions, tissue characterization, and multi-planar reconstruction• FDG-PET provides valuable information on the metabolic activity of cardiovascular disorders• PET and MRI provide complementary information on the evaluation of cardiovascular disordersElectronic supplementary materialThe online version of this article (doi:10.1007/s13244-016-0494-5) contains supplementary material, which is available to authorized users.
“…Furthermore, both methods are relatively technically challenging, secondary to complications of motion from the heart or blood flow (MRI), or to relatively complicated patient preparation and inconsistent cardiac tracer uptake (PET) [42]. Therefore, PET/MRI of the heart is a technically challenging but highly attractive application for the technique [43]. For a more extensive discussion of the early work in the field, the reader is referred to recent excellent reviews [44,45].…”
Section: Cardiovascular Applications Of Pet/mrimentioning
Combined positron emission tomography and magnetic resonance imaging (PET/MRI) is emerging as a powerful technique in clinical applications including oncology, neurology, and cardiology. In this review, we outline recent advances in the field, with particular focus on the study of neurodegenerative diseases, epilepsy, cardiac disorders, and oncology. We also highlight recent technical improvements in PET/MRI, with particular attention to attenuation correction and the integration with advanced MRI modalities including arterial spin labeling, fMRI, and hyperpolarized 13 C magnetic resonance spectroscopy.
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