Relation of regional function, perfusion, and metabolism in patients with advanced coronary artery disease undergoing surgical revascularization.

Dahl, Juergen vom; Eitzman, Daniel T.; Al-Aouar, Ziad; Kanter, H L; Hicks, Rodney J.; Deeb, G. Michael; Kirsh, Marvin M.; Schwaiger, Markus

doi:10.1161/01.cir.90.5.2356

Cited by 167 publications

(33 citation statements)

References 32 publications

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“…Among the different imaging modalities available to assess myocardial viability, 18 F-FDG PET is considered to be the gold standard (61,62). The results of several studies have proven the value of 18 F-FDG PET imaging in identifying those patients who would benefit from revascularization, based on a prediction of improved LV function (63)(64)(65).…”

Section: Evaluation Of Known or Suspected Cardiomyopathymentioning

confidence: 99%

Hybrid PET/MR Imaging of the Heart: Potential, Initial Experiences, and Future Prospects

et al. 2013

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) advantages and shortcomings of hybrid PET/MR scanners with respect to cardiovascular applications (e.g. myocardial perfusion imaging and viability imaging), (2) additional value of the MR component in cardiac imaging, and (3) technical challenges and workflow considerations regarding hybrid PET/MR scanners in the field of cardiology (e.g. attenuation correction and cardiac/respiratory/patient motion).Financial Disclosure: Dr. Schwaiger is an investigator, meeting participant, and lecturer for Siemens Medical. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, participants can access this activity through the SNMMI Web site (http:// www.snmmi.org/ce_online) through March 2016.PET/CT and other combined scanners have in the past decade rapidly emerged as important research tools and are proving to be invaluable for improved diagnostics in routine nuclear medicine. The design of hybrid PET/MR scanners presented a formidable technical challenge, and only recently were these instruments introduced to the market. Initial expectations of the performance of these scanners have been high, notably because of the potential for superior tissue contrast inherent in the MR modality, as well as the potential for multiparametric functional imaging in conjunction with PET. However, the additional value and potential clinical role that these new systems might bring to the cardiac field have yet to be documented. This review presents a comparative summary of the existing applications for PET and MR in the field of cardiology and suggests potential cardiac applications exploiting unique properties of the newly introduced combined instrumentation. The diverse range of imaging modalities for cardiology includes echocardiography, CT, MR imaging, SPECT, and PET, each of which offers distinct properties and advantages. The demand for combined PET/CT instrumentation in clinical nuclear medicine has grown remarkably, because of the notable advantages presented by hybrid imaging with respect to anatomic localization of lesions. Although these advantages were initially driven by the demands of oncology imaging, the resultant broader availability of PET/CT has provided the opportunity to use these scanners for indications beyond oncology, such as in the field of cardiac imaging (1). Furthermore, CT images are necessary for rapid attenuation correction, which is of particular importance for quantification in myocardial perfusion imaging. Through the use of suitable CT components a...

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Section: Evaluation Of Known or Suspected Cardiomyopathymentioning

confidence: 99%

Hybrid PET/MR Imaging of the Heart: Potential, Initial Experiences, and Future Prospects

et al. 2013

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“…Preserved or increased FDG uptake in the region of a perfusion defect, the so-called perfusion/metabolism mismatch, is thought to represent hibernating myocardium in this setting, which benefits from the restoration of blood flow. 27 On the contrary, in our model of acute myocardial infarction induced by ischemia and reperfusion, perfusion/metabolism mismatch indicates inflammation in otherwise nonviable scar regions as identified by CT and postmortem TTC staining. This is important to recognize because it may complicate the use of FDG for clinical viability assessment early after infarct reperfusion therapy.…”

Section: Discussionmentioning

confidence: 71%

Integration of Infarct Size, Tissue Perfusion, and Metabolism by Hybrid Cardiac Positron Emission Tomography/Computed Tomography

Lautamäki

Schuleri

Sasano

et al. 2009

Circ: Cardiovascular Imaging

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Background-Hybrid positron emission tomography/computed tomography (PET-CT) allows for combination of PET perfusion/metabolism imaging with infarct detection by CT delayed contrast enhancement. We used this technique to obtain biomorphological insights into the interrelation between tissue damage, inflammation, and microvascular obstruction early after myocardial infarction. Methods and Results-A porcine model of left anterior descending coronary artery occlusion/reperfusion was studied.Seven animals underwent PET-CT within 3 days of infarction, and a control group of 3 animals was scanned at Ͼ4 weeks. Perfusion and glucose uptake were assessed by [, and 64-slice CT delayed contrast enhancement was measured. In the acute infarct model, CT revealed a no-reflow phenomenon suggesting microvascular obstruction in 80% of all infarct segments. PET showed increased FDG uptake in 68% of the CT-defined infarct segments. Ex vivo staining and histology showed active inflammation in the acute infarct area as an explanation for increased glucose uptake. In chronic infarction, CT showed no microvascular obstruction and agreed well with matched perfusion/metabolism defects on PET. Conclusions-Perfusion/metabolism PET and delayed enhancement CT can be combined within a single hybrid PET-CT session. Increased regional FDG uptake in the acute infarct area is frequently observed. In contrast to the chronic infarct setting, this indicates tissue inflammation that is commonly associated with microvascular obstruction as identified by no reflow on CT. The consequences of these pathophysiological findings for subsequent ventricular remodeling should be explored in further studies. (Circ Cardiovasc Imaging. 2009;2:299-305.)

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“…13 Nammonia ( 13 N-NH 3 ) was used to study the regional myocardial perfusion. 18-22 18 F-2 fluoro-2-deoxyglucose ( 18 F-FDG) was used to diVerentiate between viable myocardium and scar tissue.…”

Section: Assessment Of Hibernationmentioning

confidence: 99%

“…The myocardial region with the highest uptake of 13 N-NH 3 , was taken as normal 13 N-NH 3 concentration for that patient. The abnormally perfused areas were semiquantitatively compared to the reference "normal" area.…”

Section: Assessment Of Hibernationmentioning

confidence: 99%

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Heart foundations on stamps (1)

Davies¹,

Hollman²

1998

Heart

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Objective-Severe impairment of left ventricular (LV) contraction is associated with an adverse prognosis in patients with ischaemic heart disease. Revascularisation may improve the impaired LV contraction if hibernating myocardium is present. The proportion of patients likely to benefit from this intervention is unknown. Therefore, the prevalence of hibernating myocardium in patients with ischaemic heart disease and severe impairment of LV contraction was assessed. Design-From a consecutive series of patients undergoing coronary angiography for the investigation of chest pain or LV impairment, all patients with ischaemic heart disease and an LV ejection fraction (LVEF) < 30% were identified. These patients underwent positron emission tomography (PET) to detect hibernating myocardium, identified by perfusion metabolism mismatch. Setting-A teaching hospital directly serving 500 000 people. Results-Of a total of 301 patients, 36 had ischaemic heart disease and an LVEF < 30%. Twenty-seven patients had PET images, while nine patients were not imaged because of emergency revascularisation (three), loss to follow up (one), inability to give consent (four), and age < 50 years (one, ethics committee guidelines). Imaged and non-imaged groups were similar in LV impairment, demographic characteristics, and risk factor profile. Fourteen patients (52% of the imaged or 39% of all patients with ischaemic heart disease and LVEF < 30%) had significant areas of hibernating myocardium on PET. Conclusion-It is possible that up to 50% of patients with ischaemic heart disease and severely impaired left ventricles have hibernating myocardium. (Heart 1998;80:559-564)

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Relation of regional function, perfusion, and metabolism in patients with advanced coronary artery disease undergoing surgical revascularization.

Cited by 167 publications

References 32 publications

Hybrid PET/MR Imaging of the Heart: Potential, Initial Experiences, and Future Prospects

Hybrid PET/MR Imaging of the Heart: Potential, Initial Experiences, and Future Prospects

Integration of Infarct Size, Tissue Perfusion, and Metabolism by Hybrid Cardiac Positron Emission Tomography/Computed Tomography

Heart foundations on stamps (1)

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