Coronary Artery PET/MR Imaging

Robson, Philip M.; Dweck, Marc R; Trivieri, Maria Giovanna; Abgral, Ronan; Karakatsanis, Nicolas A.; Contreras, Johanna; Gidwani, Umesh; Narula, Jagat; Fuster, Valentín; Kovacic, Jason C.; Fayad, Zahi A.

doi:10.1016/j.jcmg.2016.09.029

Cited by 99 publications

(39 citation statements)

References 33 publications

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“…However, the limited spatial resolution (1.3-1.8 mm with most current techniques), may limit the diagnostic use of CMR in clinical practice, whereas it has important research interest for future application. CMR has been recently combined with positron emission tomography (PET) for the simultaneous assessment of anatomic details and disease activity [89,90]. This hybrid PET/MR system has lower level of radiation exposure compared to PET/CT, thus allowing to monitor the progression of chronic atherosclerosis over time.…”

Section: Cardiac Magnetic Resonance (Cmr)mentioning

confidence: 99%

Coronary Atherosclerosis Imaging

et al. 2020

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Identifying patients at increased risk of coronary artery disease, before the atherosclerotic complications become clinically evident, is the aim of cardiovascular prevention. Imaging techniques provide direct assessment of coronary atherosclerotic burden and pathological characteristics of atherosclerotic lesions which may predict the progression of disease. Atherosclerosis imaging has been traditionally based on the evaluation of coronary luminal narrowing and stenosis. However, the degree of arterial obstruction is a poor predictor of subsequent acute events. More recent techniques focus on the high-resolution visualization of the arterial wall and the coronary plaques. Most acute coronary events are triggered by plaque rupture or erosion. Hence, atherosclerotic plaque imaging has generally focused on the detection of vulnerable plaque prone to rupture. However, atherosclerosis is a dynamic process and the plaque morphology and composition may change over time. Most vulnerable plaques undergo progressive transformation from high-risk to more stable and heavily calcified lesions, while others undergo subclinical rupture and healing. Although extensive plaque calcification is often associated with stable atherosclerosis, the extent of coronary artery calcification strongly correlates with the degree of atherosclerosis and with the rate of future cardiac events. Inflammation has a central role in atherogenesis, from plaque formation to rupture, hence in the development of acute coronary events. Morphologic plaque assessment, both invasive and non-invasive, gives limited information as to the current activity of the atherosclerotic disease. The addition of nuclear imaging, based on radioactive tracers targeted to the inflammatory components of the plaques, provides a highly sensitive assessment of coronary disease activity, thus distinguishing those patients who have stable disease from those with active plaque inflammation.

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Section: Cardiac Magnetic Resonance (Cmr)mentioning

confidence: 99%

Coronary Atherosclerosis Imaging

et al. 2020

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“…To provide anatomic details, PET scans are currently combined with CT or MR. Recently developed hybrid scanners PET/MR offer the possibility to simultaneous assessment of disease activity and morphological information with a lower radiation exposure compared to PET/CT [124,126]. 18 F-sodium fluoride ( 18 F-NaF) was originally studied to identify bone metastasis.…”

Section: Imaging Disease Activitymentioning

confidence: 99%

Coronary Artery Microcalcification: Imaging and Clinical Implications

Vancheri¹,

Longo²,

Vancheri

et al. 2019

Diagnostics

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Strategies to prevent acute coronary and cerebrovascular events are based on accurate identification of patients at increased cardiovascular (CV) risk who may benefit from intensive preventive measures. The majority of acute CV events are precipitated by the rupture of the thin cap overlying the necrotic core of an atherosclerotic plaque. Hence, identification of vulnerable coronary lesions is essential for CV prevention. Atherosclerosis is a highly dynamic process involving cell migration, apoptosis, inflammation, osteogenesis, and intimal calcification, progressing from early lesions to advanced plaques. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis, correlates with clinically significant coronary artery disease (CAD), predicts future CV events and improves the risk prediction of conventional risk factors. The relative importance of coronary calcification, whether it has a protective effect as a stabilizing force of high-risk atherosclerotic plaque has been debated until recently. The extent of calcium in coronary arteries has different clinical implications. Extensive plaque calcification is often a feature of advanced and stable atherosclerosis, which only rarely results in rupture. These macroscopic vascular calcifications can be detected by computed tomography (CT). The resulting CAC scoring, although a good marker of overall coronary plaque burden, is not useful to identify vulnerable lesions prone to rupture. Unlike macrocalcifications, spotty microcalcifications assessed by intravascular ultrasound or optical coherence tomography strongly correlate with plaque instability. However, they are below the resolution of CT due to limited spatial resolution. Microcalcifications develop in the earliest stages of coronary intimal calcification and directly contribute to plaque rupture producing local mechanical stress on the plaque surface. They result from a healing response to intense local macrophage inflammatory activity. Most of them show a progressive calcification transforming the early stage high-risk microcalcification into the stable end-stage macroscopic calcification. In recent years, new developments in noninvasive cardiovascular imaging technology have shifted the study of vulnerable plaques from morphology to the assessment of disease activity of the atherosclerotic lesions. Increased disease activity, detected by positron emission tomography (PET) and magnetic resonance (MR), has been shown to be associated with more microcalcification, larger necrotic core and greater rates of events. In this context, the paradox of increased coronary artery calcification observed in statin trials, despite reduced CV events, can be explained by the reduction of coronary inflammation induced by statin which results in more stable macrocalcification.

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“…The acquisition of free-breathing attenuation data could provide a rough first-hand solution in limiting the respiratory-induced attenuation-emission mismatches. 33,34 Nevertheless, a more complete solution would be the motion correction of the attenuation and emission data.…”

Section: Overview Of Physical and Imaging Factors Impacting Quantitatmentioning

confidence: 99%

Towards enhanced PET quantification in clinical oncology

Zaidi

Karakatsanis

2017

The British Journal of Radiology

101

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Positron emission tomography (PET) has, since its inception, established itself as the imaging modality of choice for the in vivo quantitative assessment of molecular targets in a wide range of biochemical processes underlying tumour physiology. PET image quantification enables to ascertain a direct link between the time-varying activity concentration in organs/tissues and the fundamental parameters portraying the biological processes at the cellular level being assessed. However, the quantitative potential of PET may be affected by a number of factors related to physical effects, hardware and software system specifications, tracer kinetics, motion, scan protocol design and limitations in current image-derived PET metrics. Given the relatively large number of PET metrics reported in the literature, the selection of the best metric for fulfilling a specific task in a particular application is still a matter of debate. Quantitative PET has advanced elegantly during the last two decades and is now reaching the maturity required for clinical exploitation, particularly in oncology where it has the capability to open many avenues for clinical diagnosis, assessment of response to treatment and therapy planning. Therefore, the preservation and further enhancement of the quantitative features of PET imaging is crucial to ensure that the full clinical value of PET imaging modality is utilized in clinical oncology. Recent advancements in PET technology and methodology have paved the way for faster PET acquisitions of enhanced sensitivity to support the clinical translation of highly quantitative four-dimensional (4D) parametric imaging methods in clinical oncology. In this report, we provide an overview of recent advances and future trends in quantitative PET imaging in the context of clinical oncology. The pros/cons of the various image-derived PET metrics will be discussed and the promise of novel methodologies will be highlighted. iNtroductioN Image-guided diagnosis and treatment response monitoring in clinical oncology has benefited significantly over the last decades from the advent of quantitative molecular imaging techniques. Among those, positron emission tomography (PET) gradually emerged as the standard-of-care molecular imaging modality in clinical oncology owing to its relatively high sensitivity and specificity for a wide spectrum of oncological malignancies across the whole human body.1 PET imaging relies on the positron/electron annihilation process to quantify the in vivo three-dimensional (3D) spatial distribution of a positron-emitting radiotracer associated with a specific molecular process. The resulting 3D PET

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Coronary Artery PET/MR Imaging

Cited by 99 publications

References 33 publications

Coronary Atherosclerosis Imaging

Coronary Atherosclerosis Imaging

Coronary Artery Microcalcification: Imaging and Clinical Implications

Towards enhanced PET quantification in clinical oncology

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