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Ren C, Pan Q, Fu C, Wang P, Zheng Z, Hsu B, Huo L. Phase I, first-in-human study of XTR004, a novel 18F-labeled tracer for myocardial perfusion PET: Biodistribution, radiation dosimetry, pharmacokinetics, and safety after a single injection at rest. J Nucl Cardiol 2024; 34:101823. [PMID: 38360262 DOI: 10.1016/j.nuclcard.2024.101823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES This study assessed the imaging characteristics, pharmacokinetics and safety of XTR004, a novel 18F-labeled Positron Emission Tomography (PET) myocardial perfusion imaging tracer, after a single injection at rest in humans. METHODS Eleven healthy subjects (eight men and three women) received intravenous XTR004 (239-290 megabecquerel [MBq]). Safety profiles were monitored on the dosing day and three follow-up visits. Multiple whole-body PET scans were conducted over 4.7 h to evaluate biodistribution and radiation dosimetry. Blood and urine samples collected for 7.25 h were metabolically corrected to characterize pharmacokinetics. RESULTS In the first 0-12 min PET images of ten subjects, liver (26.81 ± 4.01), kidney (11.43 ± 2.49), lung (6.75 ± 1.76), myocardium (4.72 ± 0.67) and spleen (3.1 ± 0.84) exhibited the highest percentage of the injected dose (%ID). Myocardial uptake of XTR004 in the myocardium initially reached 4.72 %ID and 7.06 g/mL, and negligibly changed within an hour (Δ: 7.20%, 5.95%). The metabolically corrected plasma peaked at 2.5 min (0.0013896 %ID/g) and halved at 45.2 min. Whole-body effective dose was 0.0165 millisievert (mSv)/MBq. Cumulative urine excretion was 8.18%. Treatment-related adverse events occurred in seven out of eleven subjects (63.6%), but no severe adverse event was reported. CONCLUSIONS XTR004 demonstrated a favorable safety profile, rapid, high, and stable myocardial uptake and excellent potential for PET myocardial perfusion imaging (MPI). Further exploration of XTR004 PET MPI for detecting myocardial ischemia is warranted.
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Affiliation(s)
- Chao Ren
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qingqing Pan
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chao Fu
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Peipei Wang
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhiquan Zheng
- Medical Department, Sinotau Pharmaceutical Group, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA.
| | - Li Huo
- Nuclear Medicine Department, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Sammartino AM, Falco R, Drera A, Dondi F, Bellini P, Bertagna F, Vizzardi E. "Vascular inflammation and cardiovascular disease: review about the role of PET imaging". Int J Cardiovasc Imaging 2023; 39:433-440. [PMID: 36255543 PMCID: PMC9870832 DOI: 10.1007/s10554-022-02730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
Inflammation characterizes all stages of atherothrombosis and provides a critical pathophysiological link between plaque formation and its acute rupture, leading to coronary occlusion and heart attack. In the last 20 years the possibility of quantifying the degree of inflammation of atherosclerotic plaques and, therefore, also of vascular inflammation aroused much interest. 18Fluoro-deoxy-glucose photon-emissions-tomography (18F-FDG-PET) is widely used in oncology for staging and searching metastases; in cardiology, the absorption of 18F-FDG into the arterial wall was observed for the first time incidentally in the aorta of patients undergoing PET imaging for cancer staging. PET/CT imaging with 18F-FDG and 18F-sodium fluoride (18F-NaF) has been shown to assess atherosclerotic disease in its molecular phase, when the process may still be reversible. This approach has several limitations in the clinical practice, due to lack of prospective data to justify their use routinely, but it's desirable to develop further scientific evidence to confirm this technique to detect high-risk patients for cardiovascular events.
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Affiliation(s)
- Antonio Maria Sammartino
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy.
| | - Raffaele Falco
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Andrea Drera
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Francesco Dondi
- Nuclear Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili Di Brescia, University of Brescia, Brescia, Italy
| | - Pietro Bellini
- Nuclear Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili Di Brescia, University of Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili Di Brescia, University of Brescia, Brescia, Italy
| | - Enrico Vizzardi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, University of Brescia, Brescia, Italy.
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Shi S, Liu Z, Wu Z, Zhou H, Lu J. Preparation and biological evaluation of radioiodine-labeled triphenylphosphine derivatives as mitochondrial targeting probes. J Labelled Comp Radiopharm 2021; 64:271-281. [PMID: 33870522 DOI: 10.1002/jlcr.3910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/08/2022]
Abstract
The positive-charged lipophilic triphenylphosphonium cations (TPPs+ ) have been served as mitochondrial targeting vehicles for the delivery of various probes. In this study, we developed a new method for the preparation of radioiodine-labeled TPPs+ . Four 125 I-labeled TPPs+ , [125 I] 9-[125 I] 12, were prepared from the corresponding triphenylphosphine phenylborate precursors of B 5-B 8 via an optimized copper-catalyzed one-step procedure in high radiochemical yield (>95%). After radio-HPLC purification, the final products could be obtained with high specific activity. Their physicochemical properties, in vitro cellular uptake, and ex vivo mice biodistribution were investigated. The results suggested the 125 I-labeled TPPs+ were lipophilic and could specifically accumulate in the mitochondrial-rich myocardial cells through the mitochondrial membrane potential.
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Affiliation(s)
- Shuyu Shi
- Key Laboratory of Radiopharmaceuticals, Beijing Normal University, Ministry of Education, Beijing, China.,College of Chemistry, Beijing Normal University, Beijing, China
| | - Zelan Liu
- Key Laboratory of Radiopharmaceuticals, Beijing Normal University, Ministry of Education, Beijing, China.,College of Chemistry, Beijing Normal University, Beijing, China
| | - Zhenmin Wu
- Key Laboratory of Radiopharmaceuticals, Beijing Normal University, Ministry of Education, Beijing, China.,College of Chemistry, Beijing Normal University, Beijing, China
| | - Hang Zhou
- Key Laboratory of Radiopharmaceuticals, Beijing Normal University, Ministry of Education, Beijing, China.,College of Chemistry, Beijing Normal University, Beijing, China
| | - Jie Lu
- Key Laboratory of Radiopharmaceuticals, Beijing Normal University, Ministry of Education, Beijing, China.,College of Chemistry, Beijing Normal University, Beijing, China
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Hyafil F, Chequer R, Sorbets E, Estellat C, Ducrocq G, Rouzet F, Alfaiate T, Regaieg H, Abtan J, Leygnac S, Milliner M, Imbert L, Burg S, Ben Azzouna R, Potier L, Laouénan C, Quintin C, Roussel R, Hartemann A, Montalescot G, Marie PY, Steg G, Le Guludec D. Head-to-head comparison of the diagnostic performances of Rubidium-PET and SPECT with CZT camera for the detection of myocardial ischemia in a population of women and overweight individuals. J Nucl Cardiol 2020; 27:755-768. [PMID: 30574676 DOI: 10.1007/s12350-018-01557-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to compare the diagnostic performances for the detection of myocardial ischemia of 82-Rb-PET-MPS and 99m-Tc-SPECT-MPS in overweight individuals and women. METHODS AND RESULTS Men with BMI ≥ 25 and women referred for MPS were considered for inclusion. All individuals underwent 99m-Tc-SPECT-MPS with CZT cameras and 82-Rb-PET-MPS in 3D-mode. Individuals with at least one positive MPS were referred for coronary angiography (CA) with FFR measurements. A criterion for positivity was a composite endpoint including significant stenosis on CA or, in the absence of CA, the occurrence of acute coronary event during the following year. 313 patients (46% women) with mean BMI of 31.8 ± 6.5 were included. Sensitivity for the detection of myocardial ischemia was higher with 82-Rb-PET-MPS compared with 99m-Tc-SPECT-MPS (85% vs. 57%, P < .05); specificity was equally high with both imaging techniques (93% vs. 94%, P > .05). 82-Rb-PET allowed for a more accurate detection of patients with a high-risk coronary artery disease (HR-CAD) than 99m-Tc-SPECT-MPS (AUC = 0.86 vs. 0.75, respectively; P = .04). CONCLUSIONS In women and overweight individuals, 82-Rb-PET-MPS provides higher sensitivity for the detection of myocardial ischemia than 99m-Tc-SPECT-MPS thanks to a better image quality and an improved detection of HR-CAD.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France.
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France.
| | - Renata Chequer
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Emmanuel Sorbets
- Department of Cardiology, Avicenne University Hospital, AP-HP, University Paris 13, 9300, Bobigny, France
| | - Candice Estellat
- Département de Biostatistiques, Hôpital Pitié-Salpêtrière, AP-HP, Santé Publique et Informatique Médicale, 75013, Paris, France
- INSERM, CIC-EC 1425, ECEVE UMR 1123, 75018, Paris, France
| | - Gregory Ducrocq
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - François Rouzet
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Toni Alfaiate
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Hamza Regaieg
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - Sébastien Leygnac
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Milan Milliner
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Laetitia Imbert
- Department of Nuclear Medicine, Brambois University Hospital, Lorraine University, 54500, Vandœuvre-Lès-Nancy, France
| | - Samuel Burg
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Rana Ben Azzouna
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Louis Potier
- Department of Diabetology, DHU FIRE, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Cédric Laouénan
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Caroline Quintin
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Ronan Roussel
- Department of Diabetology, DHU FIRE, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpétriêre University Hospital, AP-HP, Sorbonne University Paris 6, 75006, Paris, France
| | - Gilles Montalescot
- ACTION Study Group, Department of Cardiology, Pitié-Salpétriêre, Sorbonne Université-Paris 6, 75006, Paris, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine, Brambois University Hospital, Lorraine University, 54500, Vandœuvre-Lès-Nancy, France
| | - Gabriel Steg
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
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Chao PH, Lazari M, Hanet S, Narayanam MK, Murphy JM, van Dam RM. Automated concentration of [ 18F]fluoride into microliter volumes. Appl Radiat Isot 2018; 141:138-148. [PMID: 30243135 PMCID: PMC6502507 DOI: 10.1016/j.apradiso.2018.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/07/2018] [Accepted: 06/20/2018] [Indexed: 11/23/2022]
Abstract
Concentration of [18F]fluoride has been mentioned in literature, however, reports have lacked details about system designs, operation, and performance. Here, we describe in detail a compact, fast, fully-automated concentration system based on a micro-sized strong anion exchange cartridge. The concentration of radionuclides enables scaled-up microfluidic synthesis. Our system can also be used to provide highly concentrated [18F]fluoride with minimal water content. We demonstrate how the concentrator can produce varying concentrations of [18F]fluoride for the macroscale synthesis of N-boc-5-[18F]fluoroindole without an azeotropic drying process, while enabling high starting radioactivity. By appropriate choice of solid-phase resin, flow conditions, and eluent solution, we believe this approach can be extended beyond [18F]fluoride to other radionuclides.
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Affiliation(s)
- Philip H Chao
- Department of Bioengineering, Henry Samueli School of Engineering, UCLA, Los Angeles, CA 90095, USA; Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Mark Lazari
- Department of Bioengineering, Henry Samueli School of Engineering, UCLA, Los Angeles, CA 90095, USA; Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Sebastian Hanet
- Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Maruthi Kumar Narayanam
- Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Jennifer M Murphy
- Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - R Michael van Dam
- Department of Bioengineering, Henry Samueli School of Engineering, UCLA, Los Angeles, CA 90095, USA; Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
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Research Progress on 18F-Labeled Agents for Imaging of Myocardial Perfusion with Positron Emission Tomography. Molecules 2017; 22:molecules22040562. [PMID: 28358340 PMCID: PMC6154634 DOI: 10.3390/molecules22040562] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of death in the world. Myocardial perfusion imaging (MPI) plays a significant role in non-invasive diagnosis and prognosis of CAD. However, neither single-photon emission computed tomography nor positron emission tomography clinical MPI agents can absolutely satisfy the demands of clinical practice. In the past decades, tremendous developments happened in the field of 18F-labeled MPI tracers. This review summarizes the current state of 18F-labeled MPI tracers, basic research data of those tracers, and the future direction of MPI tracer research.
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Polte CL, Burck I, Gjertsson P, Lomsky M, Nekolla SG, Nagel E. Cardiac Positron Emission Tomography: a Clinical Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016; 43:1530-45. [PMID: 26846913 DOI: 10.1007/s00259-016-3317-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 02/06/2023]
Abstract
Until recently, PET was regarded as a luxurious way of performing myocardial perfusion scintigraphy, with excellent image quality and diagnostic capabilities that hardly justified the additional cost and procedural effort. Quantitative perfusion PET was considered a major improvement over standard qualitative imaging, because it allows the measurement of parameters not otherwise available, but for many years its use was confined to academic and research settings. In recent years, however, several factors have contributed to the renewal of interest in quantitative perfusion PET, which has become a much more readily accessible technique due to progress in hardware and the availability of dedicated and user-friendly platforms and programs. In spite of this evolution and of the growing evidence that quantitative perfusion PET can play a role in the clinical setting, there are not yet clear indications for its clinical use. Therefore, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, decided to examine the current literature on quantitative perfusion PET to (1) evaluate the rationale for its clinical use, (2) identify the main methodological requirements, (3) identify the remaining technical difficulties, (4) define the most reliable interpretation criteria, and finally (5) tentatively delineate currently acceptable and possibly appropriate clinical indications. The present position paper must be considered as a starting point aiming to promote a wider use of quantitative perfusion PET and to encourage the conception and execution of the studies needed to definitely establish its role in clinical practice.
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Shevde K, Freudzon L, Maloney M, Feltman R. Cardiac Imaging. Int Anesthesiol Clin 2016; 54:54-70. [DOI: 10.1097/aia.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Validation of pixel-wise parametric mapping of myocardial blood flow with ¹³NH₃ PET in patients with hypertrophic cardiomyopathy. Eur J Nucl Med Mol Imaging 2015; 42:1581-8. [PMID: 26121929 DOI: 10.1007/s00259-015-3101-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/28/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Transmural abnormalities in myocardial blood flow (MBF) are important causes of ischaemia in patients with left ventricular (LV) hypertrophy. The study aimed to test whether pixel-wise parametric mapping of (13)NH3 MBF can reveal transmural abnormalities in patients with hypertrophic cardiomyopathy (HCM). METHODS We submitted 11 HCM patients and 9 age-matched controls with physiological LV hypertrophy to rest and stress (dipyridamole) (13)NH3 PET. We measured MBF using a compartmental model, and obtained rest and stress parametric maps. Pixel MBF values were reorganized to obtain subendocardial and subepicardial MBF of LV segments. RESULTS MBF at rest was higher in the subendocardial than in the subepicardial layer: 0.78 ± 0.19 vs. 0.60 ± 0.18 mL/min/g in HCM patients; 0.92 ± 0.24 vs. 0.75 ± 0.24 mL/min/g in controls (both p < 0.0001). Transmural perfusion gradient (TPG = subendocardial MBF/subepicardial MBF) at rest was similar: 1.35 ± 0.31 in HCM patients; 1.28 ± 0.27 in controls (NS). During stress, controls maintained higher subendocardial MBF: 2.44 ± 0.54 vs. 1.96 ± 0.67 mL/min/g tissue (p < 0.0001), with a TPG of 1.33 ± 0.35 (NS vs. rest). In HCM patients, the difference between subendocardial and subepicardial MBF was reduced (1.46 ± 0.48 vs. 1.36 ± 0.48 mL/min/g tissue, p < 0.01) and TPG decreased to 1.11 ± 0.34 (p < 0.0001 vs. rest and vs. controls). In HCM patients 8 of 176 segments had subendocardial MBF less than -2 × SD of the mean, versus none of 144 segments in controls (p < 0.01). CONCLUSION Pixel-wise parametric mapping of (13)NH3 MBF enables the identification of transmural abnormalities in patients with HCM.
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Mou T, Zhao Z, You L, Wang Q, Fang W, Lu J, Peng C, Zhang X. Synthesis and bioevaluation of 4-chloro-2-tert-butyl-5-[2-[[1-[2-[(18) F]fluroethyl]-1H-1,2,3-triazol-4-yl]methyl]phenylmethoxy]-3(2H)-pyridazinone as potential myocardial perfusion imaging agent with PET. J Labelled Comp Radiopharm 2015; 58:349-54. [PMID: 26094722 DOI: 10.1002/jlcr.3310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 11/06/2022]
Abstract
This study reports the synthesis and characterization of 4-chloro-2-tert-butyl-5-[2-[[1-[2-[(18) F]fluroethyl]-1H-1,2,3-triazol-4-yl]methyl]phenylmethoxy]-3(2H)-pyridazinone ([(18) F]Fmp2) for myocardial perfusion imaging (MPI). The tosylate precursor and non-radioactive compound [(19) F]Fmp2 were synthesized and characterized by infrared, (1) H-NMR, (13) C-NMR, and mass spectra (MS). The radiotracer [(18) F]Fmp2 was obtained by one-step nucleophilic substitution of tosyl with (18) F, and evaluated as an MPI agent in vitro and in vivo. Starting from [(18) F]KF/K222 solution, the typical decay-corrected radiochemical yield (RCY) was 38 ± 8.8% with high radiochemical purity (>98%). The specific activity was calculated as 10 GBq/µmol at the end of synthesis determined by HPLC analysis. In the mice biodistribution, [(18) F]Fmp2 showed very high initial heart uptake (53.35 ± 5.47 %ID/g at 2 min after injection) and remarkable retention. The heart/liver, heart/lung, and heart/blood ratios were 7.98, 8.20, and 53.13, respectively at 2 min post-injection. In the Positron Emission Tomography (PET) imaging study of Chinese mini-swine, the standardized uptake value of the liver decreased modestly during the 2 h post-injection, while the heart uptake and heart/liver ratios continued to increase with time. [(18) F]Fmp2 exhibited good stability, high heart uptake and low lung uptake in mice and Chinese mini-swine. It may be worthy of further modification to improve liver clearance for MPI in the future.
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Affiliation(s)
- Tiantian Mou
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361005, China.,Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Zuoquan Zhao
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Linyi You
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361005, China
| | - Qian Wang
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Wei Fang
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Jie Lu
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, 100875, China
| | - Cheng Peng
- PET Center, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, 100053, China
| | - Xianzhong Zhang
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361005, China
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Molecular imaging of plaques in coronary arteries with PET and SPECT. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:259-73. [PMID: 25278976 PMCID: PMC4178519 DOI: 10.11909/j.issn.1671-5411.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 01/26/2023]
Abstract
Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lumen stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increasingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography (PET) and single photon emission computed tomography (SPECT) has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging techniques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coronary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.
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Millar BC, Prendergast BD, Alavi A, Moore JE. 18FDG-positron emission tomography (PET) has a role to play in the diagnosis and therapy of infective endocarditis and cardiac device infection. Int J Cardiol 2013; 167:1724-36. [DOI: 10.1016/j.ijcard.2012.12.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/19/2012] [Accepted: 12/01/2012] [Indexed: 12/15/2022]
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14
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Alliot C, Audouin N, Bonraisin AC, Bossé V, Laizé J, Bourdeau C, Mokili BM, Michel N, Haddad F. 82Sr purification procedure using Chelex-100 resin. Appl Radiat Isot 2013; 74:56-60. [PMID: 23360750 DOI: 10.1016/j.apradiso.2012.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 10/10/2012] [Accepted: 10/12/2012] [Indexed: 11/27/2022]
Abstract
(82)Rb is a positron-emitting radionuclide widely used in nuclear cardiology. One great advantage is its availability through a generator loaded with (82)Sr. (82)Sr can be produced in a high energy cyclotron by irradiating rubidium chloride target with proton beam. In this paper, we present an extensive study (elution profiles, effect of the elution flow rate) on the use of Chelex-100 resin and ammonia buffer. No significant effect of flow rate was evidenced between 1 and 10mL/min leading us to propose a purification process which can be easily automated.
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Affiliation(s)
- C Alliot
- GIP Arronax, 1 rue Arronax, Saint-Herblain, France.
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15
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Williams BA, Dorn JM, LaMonte MJ, Donahue RP, Trevisan M, Leonard DA, Greene RS, Merhige ME. Evaluating the prognostic value of positron-emission tomography myocardial perfusion imaging using automated software to calculate perfusion defect size. Clin Cardiol 2012; 35:E14-21. [PMID: 22961671 DOI: 10.1002/clc.22058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 08/09/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Myocardial perfusion imaging by positron-emission tomography (PET MPI) is regarded as a valid technique for the diagnosis of coronary artery disease (CAD), but the incremental prognostic value of PET MPI among individuals with known or suspected CAD is not firmly established. HYPOTHESIS Myocardial perfusion defect sizes as measured by PET MPI using automated software will provide incremental prognostic value for cardiac and all-cause mortality. METHODS This study included 3739 individuals who underwent rest-stress rubidium-82 PET MPI for the evaluation of known or suspected CAD. Rest, stress, and stress-induced myocardial perfusion defect sizes were determined objectively by automated computer software. Study participants were followed for a mean of 5.2 years for cardiac and all-cause mortality. Cox proportional hazards models were developed to evaluate the incremental prognostic value of PET MPI. RESULTS A strong correlation was observed between perfusion defect sizes assessed visually and by automated software (r = 0.76). After adjusting for cardiac risk factors, known CAD, noncoronary vascular disease, and use of cardioprotective medications, stress perfusion defect size was strongly associated with cardiac death (P < 0.001). Rest perfusion defects demonstrated a stronger association with cardiac death (P < 0.001) than stress-induced perfusion defects (P = 0.01), yet both were highly significant. Similar patterns held for all-cause death. CONCLUSIONS The current study is the largest to date demonstrating PET MPI provides incremental prognostic value among individuals with known or suspected CAD. Automated calculation of perfusion defect sizes may provide valuable supplementary information to visual assessment.
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Affiliation(s)
- Brent A Williams
- Department of Center for Health Research, Geisinger Health System, Danville, PA 17822, USA.
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16
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Notghi A, Low CS. Myocardial perfusion scintigraphy: past, present and future. Br J Radiol 2012; 84 Spec No 3:S229-36. [PMID: 22723530 DOI: 10.1259/bjr/14625142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
During the last two decades, radionuclide myocardial perfusion scintigraphy (MPS) has become established as the main functional cardiac imaging technique for the assessment of ischaemic heart disease (IHD). Despite a growing number of alternative functional imaging techniques, MPS still remains the most widely used technique, with a wealth of literature supporting its usefulness in assessing IHD and predicting prognosis. The technique itself has evolved, making it more reliable and robust, with additional ventricular functional information that further defines the prognosis in these patients. With the advent of hybrid single photon emission with CT and positron emission tomography with CT cameras together with the development of new camera technology that enables faster images with less radiation and better resolution, MPS will remain an essential part of IHD investigation. There are new promising radiopharmacological developments and applications such as radiolabelled fatty acids and meta-iodobenzylguanidine. These will widen the scope of nuclear medicine imaging to include patients with cardiac failure and acute chest pain presenting to accident and emergency departments. Nuclear medicine cardiac investigations will continue to have an essential role in the diagnosis, stratification and prognosis of patients with cardiac disease, complementing the new developing cardiac modalities such as CT coronary angiography and MRI.
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Affiliation(s)
- A Notghi
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
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Sciagrà R. Quantitative cardiac positron emission tomography: the time is coming! SCIENTIFICA 2012; 2012:948653. [PMID: 24278760 PMCID: PMC3820449 DOI: 10.6064/2012/948653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/14/2012] [Indexed: 06/02/2023]
Abstract
In the last 20 years, the use of positron emission tomography (PET) has grown dramatically because of its oncological applications, and PET facilities are now easily accessible. At the same time, various groups have explored the specific advantages of PET in heart disease and demonstrated the major diagnostic and prognostic role of quantitation in cardiac PET. Nowadays, different approaches for the measurement of myocardial blood flow (MBF) have been developed and implemented in user-friendly programs. There is large evidence that MBF at rest and under stress together with the calculation of coronary flow reserve are able to improve the detection and prognostication of coronary artery disease. Moreover, quantitative PET makes possible to assess the presence of microvascular dysfunction, which is involved in various cardiac diseases, including the early stages of coronary atherosclerosis, hypertrophic and dilated cardiomyopathy, and hypertensive heart disease. Therefore, it is probably time to consider the routine use of quantitative cardiac PET and to work for defining its place in the clinical scenario of modern cardiology.
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Affiliation(s)
- Roberto Sciagrà
- Department of Clinical Physiopathology, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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18
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Mou T, Zhao Z, Fang W, Peng C, Guo F, Liu B, Ma Y, Zhang X. Synthesis and Preliminary Evaluation of 18F-Labeled Pyridaben Analogues for Myocardial Perfusion Imaging with PET. J Nucl Med 2012; 53:472-9. [PMID: 22302832 DOI: 10.2967/jnumed.111.088096] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tiantian Mou
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China
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Lodi F, Malizia C, Castellucci P, Cicoria G, Fanti S, Boschi S. Synthesis of oncological [11C]radiopharmaceuticals for clinical PET. Nucl Med Biol 2011; 39:447-60. [PMID: 22172394 DOI: 10.1016/j.nucmedbio.2011.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 10/14/2011] [Accepted: 10/22/2011] [Indexed: 01/05/2023]
Abstract
Positron emission tomography (PET) is a nuclear medicine modality which provides quantitative images of biological processes in vivo at the molecular level. Several PET radiopharmaceuticals labeled with short-lived isotopes such as (18)F and (11)C were developed in order to trace specific cellular and molecular pathways with the aim of enhancing clinical applications. Among these [(11)C]radiopharmaceuticals are N-[(11)C]methyl-choline ([(11)C]choline), l-(S-methyl-[(11)C])methionine ([(11)C]methionine) and 1-[(11)C]acetate ([(11)C]acetate), which have gained an important role in oncology where the application of 2-[(18)F]fluoro-2-deoxy-d-glucose ([(18)F]FDG) is suboptimal. Nevertheless, the production of these radiopharmaceuticals did not reach the same level of standardization as for [(18)F]FDG synthesis. This review describes the most recent developments in the synthesis of the above-mentioned [(11)C]radiopharmaceuticals aiming to increase the availability and hence the use of [(11)C]choline, [(11)C]methionine and [(11)C]acetate in clinical practice.
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Affiliation(s)
- Filippo Lodi
- PET Radiopharmacy, Nuclear Medicine Unit, Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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20
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Danad I, Raijmakers PG, Appelman YE, Harms HJ, de Haan S, van den Oever MLP, van Kuijk C, Allaart CP, Hoekstra OS, Lammertsma AA, Lubberink M, van Rossum AC, Knaapen P. Coronary risk factors and myocardial blood flow in patients evaluated for coronary artery disease: a quantitative [15O]H2O PET/CT study. Eur J Nucl Med Mol Imaging 2011; 39:102-12. [PMID: 22005845 PMCID: PMC3227802 DOI: 10.1007/s00259-011-1956-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 09/27/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND There has been increasing interest in quantitative myocardial blood flow (MBF) imaging over the last years and it is expected to become a routinely used technique in clinical practice. Positron emission tomography (PET) using [(15)O]H(2)O is the established gold standard for quantification of MBF in vivo. A fundamental issue when performing quantitative MBF imaging is to define the limits of MBF in a clinically suitable population. The aims of the present study were to determine the limits of MBF and to determine the relationship among coronary artery disease (CAD) risk factors, gender and MBF in a predominantly symptomatic patient cohort without significant CAD. METHODS A total of 128 patients (mean age 54 ± 10 years, 50 men) with a low to intermediate pretest likelihood of CAD were referred for noninvasive evaluation of CAD using a hybrid PET/computed tomography (PET/CT) scanner. MBF was quantified with [(15)O]H(2)O at rest and during adenosine-induced hyperaemia. Obstructive CAD was excluded in these patients by means of invasive or CT-based coronary angiography. RESULTS Global average baseline MBF values were 0.91 ± 0.34 and 1.09 ± 0.30 ml·min(-1)·g(-1) (range 0.54-2.35 and 0.59-2.75 ml·min(-1)·g(-1)) in men and women, respectively (p < 0.01). However, no gender-dependent difference in baseline MBF was seen following correction for rate-pressure product (0.98 ± 0.45 and 1.09 ± 0.30 ml·min(-1)·g(-1) in men and women, respectively; p = 0.08). Global average hyperaemic MBF values were 3.44 ± 1.20 ml·min(-1)·g(-1) in the whole study population, and 2.90 ± 0.85 and 3.78 ± 1.27 ml·min(-1)·g(-1) (range 1.52-5.22 and 1.72-8.15 ml·min(-1)·g(-1)) in men and women, respectively (p < 0.001). Multivariate analysis identified male gender, age and body mass index as having an independently negative impact on hyperaemic MBF. CONCLUSION Gender, age and body mass index substantially influence reference values and should be corrected for when interpreting hyperaemic MBF values.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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Bettinardi V, Presotto L, Rapisarda E, Picchio M, Gianolli L, Gilardi MC. Physical Performance of the new hybrid PET/CT Discovery-690. Med Phys 2011; 38:5394-411. [DOI: 10.1118/1.3635220] [Citation(s) in RCA: 289] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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Abstract
Atherosclerosis is an inflammatory disease that causes most myocardial infarctions, strokes and acute coronary syndromes. Despite the identification of multiple risk factors and widespread use of drug therapies, it still remains a global health concern with associated costs. Although angiography is established as the gold standard means of detecting coronary artery stenosis, it does not image the vessel wall itself, reporting only on its consequences such as luminal narrowing and obstruction. MRI and computed tomography provide more information about the plaque structure, but recently positron emission tomography (PET) imaging using [(18) F]-fluorodeoxyglucose (FDG) has been advocated as a means of measuring arterial inflammation. This results from the ability of FDG-PET to highlight areas of high glucose metabolism, a feature of macrophages within atherosclerosis, particularly in high-risk plaques. It is suggested that the degree of FDG accumulation in the vessel wall reflects underlying inflammation levels and that tracking any changes in FDG uptake over time or with drug therapy might be a way of getting an early efficacy readout for novel anti-atherosclerotic drugs. Early reports also demonstrate that FDG uptake is correlated with the number of cardiovascular risk factors and possibly even the risk of future cardiovascular events. This review will outline the evidence base, shortcomings and emerging applications for FDG-PET in vascular imaging. Alternative PET tracers and other candidate imaging modalities for measuring vascular inflammation will also be discussed.
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Affiliation(s)
- F Joshi
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
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23
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Flotats A, Knuuti J, Gutberlet M, Marcassa C, Bengel FM, Kaufmann PA, Rees MR, Hesse B. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging 2011; 38:201-12. [PMID: 20717824 DOI: 10.1007/s00259-010-1586-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Improvements in software and hardware have enabled the integration of dual imaging modalities into hybrid systems, which allow combined acquisition of the different data sets. Integration of positron emission tomography (PET) and computed tomography (CT) scanners into PET/CT systems has shown improvement in the management of patients with cancer over stand-alone acquired CT and PET images. Hybrid cardiac imaging either with single photon emission computed tomography (SPECT) or PET combined with CT depicts cardiac and vascular anatomical abnormalities and their physiologic consequences in a single setting and appears to offer superior information compared with either stand-alone or side-by-side interpretation of the data sets in patients with known or suspected coronary artery disease (CAD). Hybrid systems are also advantageous for the patient because of the single short dual data acquisition. However, hybrid cardiac imaging has also generated controversy with regard to which patients should undergo such integrated examination for clinical effectiveness and minimization of costs and radiation dose, and if software-based fusion of images obtained separately would be a useful alternative. The European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC) in this paper want to present a position statement of the institutions on the current roles of SPECT/CT and PET/CT hybrid cardiac imaging in patients with known or suspected CAD.
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Affiliation(s)
- Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M. Claret, 167, 08025, Barcelona, Spain.
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Laffon E, de Clermont H, Bordenave L. [PET-CT in thoracic disease]. Rev Mal Respir 2010; 27:1275-80. [PMID: 21163403 DOI: 10.1016/j.rmr.2010.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 05/26/2010] [Indexed: 10/18/2022]
Abstract
PET-CT imaging merges metabolic data obtained after injection of a tracer labelled with a positron emitter, with CT anatomical data. This whole-body technique provides (i) an improved spatial resolution and (ii) when the tracer is ¹⁸FDG, quantification of tissue glucose metabolism. In thoracic oncology, ¹⁸FDG PET-CT imaging allows diagnosis, staging, follow-up of treatment efficiency, and detection of recurrence. Furthermore, its potential usefulness in inflammatory and infectious diseases should be emphasized. Its main contra-indication is pregnancy, and a good knowledge of its technical procedure is mandatory. The most currently used quantification index is the standardized uptake value (SUV), whose interpretation requires caution.
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Affiliation(s)
- E Laffon
- Service de Médecine Nucléaire, Hôpital du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac, France.
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25
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Rudd JHF, Narula J, Strauss HW, Virmani R, Machac J, Klimas M, Tahara N, Fuster V, Warburton EA, Fayad ZA, Tawakol AA. Imaging atherosclerotic plaque inflammation by fluorodeoxyglucose with positron emission tomography: ready for prime time? J Am Coll Cardiol 2010; 55:2527-35. [PMID: 20513592 DOI: 10.1016/j.jacc.2009.12.061] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 11/09/2009] [Accepted: 12/14/2009] [Indexed: 01/12/2023]
Abstract
Inflammation is a determinant of atherosclerotic plaque rupture, the event leading to most myocardial infarctions and strokes. Although conventional imaging techniques identify the site and severity of luminal stenosis, the inflammatory status of the plaque is not addressed. Positron emission tomography imaging of atherosclerosis using the metabolic marker fluorodeoxyglucose allows quantification of arterial inflammation across multiple vessels. This review sets out the background and current and potential future applications of this emerging biomarker of cardiovascular risk, along with its limitations.
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Affiliation(s)
- James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, England.
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26
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Knaapen P, de Haan S, Hoekstra O, Halbmeijer R, Appelman Y, Groothuis J, Comans E, Meijerink M, Lammertsma A, Lubberink M, Götte M, van Rossum A. Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease. Neth Heart J 2010; 18:90-8. [PMID: 20200615 PMCID: PMC2828569 DOI: 10.1007/bf03091744] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hybrid imaging of positron emission tomography (PET) together with computed tomography (CT) is rapidly emerging. In cardiology, this new advanced hybrid imaging modality allows quantification of cardiac perfusion in combination with assessment of coronary anatomy within a single scanning session of less than 45 minutes. The near-simultaneous anatomical evaluation of coronary arteries using CT and corresponding functional status using PET provides a wealth of complementary information in patients who are being evaluated for (suspected) coronary artery disease, and could help guide clinical patient management in a novel manner. Clinical experience gained with this recently introduced advanced hybrid imaging tool, however, is still limited and its implementation into daily clinical practice remains largely unchartered territory. This review discusses principles of perfusion PET, its diagnostic accuracy, and potential clinical applications of cardiac PET-CT in patients with ischaemic heart disease. (Neth Heart J 2010;18:90-8.).
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Affiliation(s)
- P. Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - S. de Haan
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - O.S. Hoekstra
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - R. Halbmeijer
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Y.E. Appelman
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - J.G.J. Groothuis
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - E.F. Comans
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M.R. Meijerink
- Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands
| | - A.A. Lammertsma
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M. Lubberink
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M.J.W. Götte
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - A.C. van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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Boehm J, Haas F, Bauernschmitt R, Wagenpfeil S, Voss B, Schwaiger M, Lange R. Impact of preoperative positron emission tomography in patients with severely impaired LV-function undergoing surgical revascularization. Int J Cardiovasc Imaging 2010; 26:423-32. [PMID: 20091350 PMCID: PMC2852592 DOI: 10.1007/s10554-010-9585-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 01/07/2010] [Indexed: 12/03/2022]
Abstract
In patients with ischemic cardiomyopathy, coronary artery bypass grafting (CABG) offers an important therapeutic option but is still associated with high perioperative mortality. Although previous studies suggest a benefit from revascularization for patients with defined viability by a non-invasive technique, the role of viability assessment to determine suitability for revascularization in patients with ischemic cardiomyopathy has not yet been defined. This study evaluates the hypothesis that the use of PET imaging in the decision-making process for CABG will improve postoperative patient survival. We reviewed 476 patients with ischemic cardiomyopathy (LV ejection fraction ≤0.35) who were considered candidates for CABG between 1994 and 2004 on the basis of clinical presentation and angiographic data. In a Standard Care Group, 298 patients underwent CABG. In a second PET-assisted management group of 178 patients, 152 patients underwent CABG (PET-CABG) and 26 patients were excluded from CABG because of lack of viability (PET-Alternatives). Primary endpoint was postoperative survival. There were two in hospital deaths in the PET-CABG (1.3%) and 30 (10.1%) in the Standard Care Group (P = 0.018). The survival rate after 1, 5 and 9.3 years was 92.0, 73.3 and 54.2% in the PET-CABG and 88.9, 62.2 and 35.5% in the Standard Care Group, respectively (P = 0.005). Cox-regression analysis revealed a significant influence on long-term survival of patient selection by viability assessment via PET (P = 0.008), of LV-function (P = 0.017), and age >70 (P = 0.016). Preoperative assessment of myocardial viability via PET identifies patients, who will benefit most from CABG.
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Affiliation(s)
- Johannes Boehm
- Klinik fuer Herz- und Gefaesschirurgie, Deutsches Herzzentrum Muenchen, Technische Universitaet Muenchen, Lazarettstrasse 36, 80636, Munich, Germany.
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28
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Groves AM, Speechly-Dick ME, Kayani I, Pugliese F, Endozo R, McEwan J, Menezes LJ, Habib SB, Prvulovich E, Ell PJ. First experience of combined cardiac PET/64-detector CT angiography with invasive angiographic validation. Eur J Nucl Med Mol Imaging 2009; 36:2027-33. [PMID: 19618180 DOI: 10.1007/s00259-009-1213-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 06/23/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE Despite modern CT systems and expert evaluators, the diagnostic performance of coronary CT angiography is limited by overestimation of vessel stenosis which reduces the positive predictive value (PPV) of the test. The aim of this study was to evaluate the performance of combined cardiac PET/64-detector CT angiography. METHODS Included in this retrospective study were 33 consecutive patients (5 women, 28 men; mean age 61.6 years, range 47-87 years, mean BMI 27.3+/-5.2 kg/m(2)) with clinically suspected flow-limiting coronary artery disease who underwent combined cardiac PET/64-detector CT angiography and invasive angiography. Combined PET/CT images were reported by an experienced dual-accredited radiologist/nuclear physician. An experienced cardiac CT radiologist re-read the CT images without PET. Stenotic disease was defined as >50% vessel narrowing. Invasive coronary angiography was used as a reference standard. Local ethics committee approval and patient consent were obtained. RESULTS CT angiography (without PET data) was concordant with invasive angiography in 31/33 patients and at a patient level, the sensitivity in detecting significant coronary artery lesions was 100%, the specificity was 82%, the PPV was 92% and the negative predictive value (NPV) was 100%. Using combined PET/CT angiography the findings were concordant with invasive angiography in 32/33 patients and at a patient level, the sensitivity was 96%, the specificity was 100%, the PPV was 100% and the NPV was 91%. CONCLUSION The use of integrated cardiac PET/64-detector CT angiography is feasible and appears to improve some aspects of the diagnostic performance of 64-detector coronary artery angiography in detecting coronary artery disease.
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Affiliation(s)
- Ashley M Groves
- Institute of Nuclear Medicine, University College London, T-5 235 Euston Rd, London NW1 2BU, UK.
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Lautamäki R, Schuleri KH, Sasano T, Javadi MS, Youssef A, Merrill J, Nekolla SG, Abraham MR, Lardo AC, Bengel FM. Integration of Infarct Size, Tissue Perfusion, and Metabolism by Hybrid Cardiac Positron Emission Tomography/Computed Tomography. Circ Cardiovasc Imaging 2009; 2:299-305. [DOI: 10.1161/circimaging.108.846253] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
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 >4 weeks. Perfusion and glucose uptake were assessed by [
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N]-ammonia/[
18
F]-deoxyglucose (FDG), 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.
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Affiliation(s)
- Riikka Lautamäki
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Karl H. Schuleri
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Tetsuo Sasano
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Mehrbod S. Javadi
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Amr Youssef
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Jennifer Merrill
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Stephan G. Nekolla
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - M. Roselle Abraham
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Albert C. Lardo
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Frank M. Bengel
- From the Department of Radiology (R.L. M.S.J., J.M., F.M.B.), Division of Nuclear Medicine, the Department of Medicine (K.H.S., T.S., A.Y., R.A., A.C.L.), Division of Cardiology, and the Department of Biomedical Engineering (A.C.L.), Johns Hopkins Medical Institutions, Baltimore, Md, and Nuklearmedizinische Klinik und Poliklinik (S.G.N.), Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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