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Gao M, Wen W, Li H, Zheng Y, Yun M, Meng J, Wang S, Wang B, Hu B, Mou T, Yu Y, Zhang X, Li X. Coronary sodium [ 18F]fluoride activity predicts outcomes post-CABG: a comparative evaluation with conventional metrics. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06736-4. [PMID: 38730084 DOI: 10.1007/s00259-024-06736-4] [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: 01/11/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE The value of preoperative multidisciplinary approach remains inadequately delineated in forecasting postoperative outcomes of patients undergoing coronary artery bypass grafting (CABG). Herein, we aimed to ascertain the efficacy of multi-modality cardiac imaging in predicting post-CABG cardiovascular outcomes. METHODS Patients with triple coronary artery disease underwent cardiac sodium [18F]fluoride ([18F]NaF) positron emission tomography/computed tomography (PET/CT), coronary angiography, and CT-based coronary artery calcium scoring before CABG. The maximum coronary [18F]NaF activity (target-to-blood ratio [TBR]max) and the global coronary [18F]NaF activity (TBRglobal) was determined. The primary endpoint was perioperative myocardial infarction (PMI) within 7-day post-CABG. Secondary endpoint included major adverse cardiac and cerebrovascular events (MACCEs) and recurrent angina. RESULTS This prospective observational study examined 101 patients for a median of 40 months (interquartile range: 19-47 months). Both TBRmax (odds ratio [OR] = 1.445; p = 0.011) and TBRglobal (OR = 1.797; P = 0.018) were significant predictors of PMI. TBRmax>3.0 (area under the curve [AUC], 0.65; sensitivity, 75.0%; specificity, 56.8%; p = 0.036) increased PMI risk by 3.661-fold, independent of external confounders. Kaplan-Meier test revealed a decrease in MACCE survival rate concomitant with an escalating TBRmax. TBRmax>3.6 (AUC, 0.70; sensitivity, 76.9%; specificity, 73.9%; p = 0.017) increased MACCEs risk by 5.520-fold. Both TBRmax (hazard ratio [HR], 1.298; p = 0.004) and TBRglobal (HR = 1.335; p = 0.011) were significantly correlated with recurrent angina. No significant associations were found between CAC and SYNTAX scores and between PMI occurrence and long-term MACCEs. CONCLUSION Quantification of coronary microcalcification activity via [18F]NaF PET displayed a strong ability to predict early and long-term post-CABG cardiovascular outcomes, thereby outperforming conventional metrics of coronary macrocalcification burden and stenosis severity. TRIAL REGISTRATION The trial was registered with the Chinese Clinical Trial Committee (number: ChiCTR1900022527; URL: www.chictr.org.cn/showproj.html?proj=37933 ).
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Affiliation(s)
- Mingxin Gao
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wanwan Wen
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China
| | - Haiyang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yaqi Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Mingkai Yun
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China
| | - Jingjing Meng
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China
| | - Shipan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Bolin Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Biao Hu
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China
| | - Tiantian Mou
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Chaoyang District, Beijing, 10029, China.
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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Kwiecinski J. Role of 18F-sodium fluoride positron emission tomography in imaging atherosclerosis. J Nucl Cardiol 2024; 35:101845. [PMID: 38479575 DOI: 10.1016/j.nuclcard.2024.101845] [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: 12/17/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/08/2024]
Abstract
Atherosclerosis involving vascular beds across the human body remains the leading cause of death worldwide. Coronary and peripheral artery disease, which are almost universally a result of atherosclerotic plaque, can manifest clinically as myocardial infarctions, ischemic stroke, or acute lower-limb ischemia. Beyond imaging myocardial perfusion and blood-flow, nuclear imaging has the potential to depict the activity of the processes that are directly implicated in the atherosclerotic plaque progression and rupture. Out of several tested tracers to date, the literature is most advanced for 18F-sodium fluoride positron emission tomography. In this review, we present the latest data in the field of atherosclerotic 18F-sodium fluoride positron emission tomography imaging, discuss the advantages and limitation of the techniques, and highlight the aspects that require further research in the future.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
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3
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Rausch I, Beitzke D, Li X, Pfaff S, Rasul S, Haug AR, Mayerhoefer ME, Hacker M, Beyer T, Cal-González J. Accuracy of PET quantification in [ 68Ga]Ga-pentixafor PET/MR imaging of carotid plaques. J Nucl Cardiol 2022; 29:492-502. [PMID: 32696137 PMCID: PMC8993720 DOI: 10.1007/s12350-020-02257-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study was to evaluate and correct for partial-volume-effects (PVE) on [68Ga]Ga-Pentixafor uptake in atherosclerotic plaques of the carotid arteries, and the impact of ignoring bone in MR-based attenuation correction (MR-AC). METHODS Twenty [68Ga]Ga-pentixafor PET/MR examinations including a high-resolution T2-TSE MR of the neck were included in this study. Carotid plaques located at the carotid bifurcation were delineated and the anatomical information was used for partial-volume-correction (PVC). Mean and max tissue-to-background ratios (TBR) of the [68Ga]Ga-Pentixafor uptake were compared for standard and PVC-PET images. A potential influence of ignoring bone in MR-AC was assessed in a subset of the data reconstructed after incorporating bone into MR-AC and a subsequent comparison of standardized-uptake values (SUV). RESULTS In total, 34 atherosclerotic plaques were identified. Following PVC, mean and max TBR increased by 77 and 95%, respectively, when averaged across lesions. When accounting for bone in the MR-AC, SUV of plaque changed by 0.5%. CONCLUSION Quantitative readings of [68Ga]Ga-pentixafor uptake in plaques are strongly affected by PVE, which can be reduced by PVC. Including bone information into the MR-AC yielded no clinically relevant effect on tracer quantification.
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Affiliation(s)
- Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sahra Pfaff
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Christian Doppler Lab for Applied Metabolomics, Medical University of Vienna, Vienna, Austria
| | - Marius E Mayerhoefer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jacobo Cal-González
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Mayer J, Jin Y, Wurster TH, Makowski MR, Kolbitsch C. Evaluation of synergistic image registration for motion-corrected coronary NaF-PET-MR. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2021; 379:20200202. [PMID: 33966463 PMCID: PMC8107649 DOI: 10.1098/rsta.2020.0202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Coronary artery disease (CAD) is caused by the formation of plaques in the coronary arteries and is one of the most common cardiovascular diseases. NaF-PET can be used to assess plaque composition, which could be important for therapy planning. One of the main challenges of NaF-PET is cardiac and respiratory motion which can strongly impair diagnostic accuracy. In this study, we investigated the use of a synergistic image registration approach which combined motion-resolved MR and PET data to estimate cardiac and respiratory motion. This motion estimation could then be used to improve the NaF-PET image quality. The approach was evaluated with numerical simulations and in vivo scans of patients suffering from CAD. In numerical simulations, it was shown, that combining MR and PET information can improve the accuracy of motion estimation by more than 15%. For the in vivo scans, the synergistic image registration led to an improvement in uptake visualization. This is the first study to assess the benefit of combining MR and NaF-PET for cardiac and respiratory motion estimation. Further patient evaluation is required to fully evaluate the potential of this approach. This article is part of the theme issue 'Synergistic tomographic image reconstruction: part 1'.
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Affiliation(s)
- Johannes Mayer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Yining Jin
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Thomas-Heinrich Wurster
- Klinik für Kardiologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Marcus R. Makowski
- Department of Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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Mayer J, Wurster TH, Schaeffter T, Landmesser U, Morguet A, Bigalke B, Hamm B, Brenner W, Makowski MR, Kolbitsch C. Imaging coronary plaques using 3D motion-compensated [ 18F]NaF PET/MR. Eur J Nucl Med Mol Imaging 2021; 48:2455-2465. [PMID: 33474584 PMCID: PMC8241750 DOI: 10.1007/s00259-020-05180-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/26/2020] [Indexed: 12/19/2022]
Abstract
Background Cardiac PET has recently found novel applications in coronary atherosclerosis imaging using [18F]NaF as a radiotracer, highlighting vulnerable plaques. However, the resulting uptakes are relatively small, and cardiac motion and respiration-induced movement of the heart can impair the reconstructed images due to motion blurring and attenuation correction mismatches. This study aimed to apply an MR-based motion compensation framework to [18F]NaF data yielding high-resolution motion-compensated PET and MR images. Methods Free-breathing 3-dimensional Dixon MR data were acquired, retrospectively binned into multiple respiratory and cardiac motion states, and split into fat and water fraction using a model-based reconstruction framework. From the dynamic MR reconstructions, both a non-rigid cardiorespiratory motion model and a motion-resolved attenuation map were generated and applied to the PET data to improve image quality. The approach was tested in 10 patients and focal tracer hotspots were evaluated concerning their target-to-background ratio, contrast-to-background ratio, and their diameter. Results MR-based motion models were successfully applied to compensate for physiological motion in both PET and MR. Target-to-background ratios of identified plaques improved by 7 ± 7%, contrast-to-background ratios by 26 ± 38%, and the plaque diameter decreased by −22 ± 18%. MR-based dynamic attenuation correction strongly reduced attenuation correction artefacts and was not affected by stent-related signal voids in the underlying MR reconstructions. Conclusions The MR-based motion correction framework presented here can improve the target-to-background, contrast-to-background, and width of focal tracer hotspots in the coronary system. The dynamic attenuation correction could effectively mitigate the risk of attenuation correction artefacts in the coronaries at the lung-soft tissue boundary. In combination, this could enable a more reproducible and reliable plaque localisation. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05180-4.
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Affiliation(s)
- Johannes Mayer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Berlin, Germany.
| | - Thomas-Heinrich Wurster
- Klinik für Kardiologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Berlin, Germany.,School of Biomedical Imaging Sciences, King's College London, London, UK.,Department of Medical Engineering, Technische Universität Berlin, Berlin, Germany
| | - Ulf Landmesser
- Klinik für Kardiologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Morguet
- Klinik für Kardiologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
| | - Boris Bigalke
- Klinik für Kardiologie, Charité Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus R Makowski
- Department of Medical Engineering, Technische Universität Berlin, Berlin, Germany.,Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Berlin, Germany.,School of Biomedical Imaging Sciences, King's College London, London, UK
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Lassen ML, Beyer T, Berger A, Beitzke D, Rasul S, Büther F, Hacker M, Cal-González J. Data-driven, projection-based respiratory motion compensation of PET data for cardiac PET/CT and PET/MR imaging. J Nucl Cardiol 2020; 27:2216-2230. [PMID: 30761482 DOI: 10.1007/s12350-019-01613-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Respiratory patient motion causes blurring of the PET images that may impact accurate quantification of perfusion and infarction extents in PET myocardial viability studies. In this study, we investigate the feasibility of correcting for respiratory motion directly in the PET-listmode data prior to image reconstruction using a data-driven, projection-based, respiratory motion compensation (DPR-MoCo) technique. METHODS The DPR-MoCo method was validated using simulations of a XCAT phantom (Biograph mMR PET/MR) as well as experimental phantom acquisitions (Biograph mCT PET/CT). Seven patient studies following a dual-tracer (18F-FDG/13N-NH3) imaging-protocol using a PET/MR-system were also evaluated. The performance of the DPR-MoCo method was compared against reconstructions of the acquired data (No-MoCo), a reference gate method (gated) and an image-based MoCo method using the standard reconstruction-transform-average (RTA-MoCo) approach. The target-to-background ratio (TBRLV) in the myocardium and the noise in the liver (CoVliver) were evaluated for all acquisitions. For all patients, the clinical effect of the DPR-MoCo was assessed based on the end-systolic (ESV), the end-diastolic volumes (EDV) and the left ventricular ejection fraction (EF) which were compared to functional values obtained from the cardiac MR. RESULTS The DPR-MoCo and the No-MoCo images presented with similar noise-properties (CoV) (P = .12), while the RTA-MoCo and reference-gate images showed increased noise levels (P = .05). TBRLV values increased for the motion limited reconstructions when compared to the No-MoCo reconstructions (P > .05). DPR-MoCo results showed higher correlation with the functional values obtained from the cardiac MR than the No-MoCo results, though non-significant (P > .05). CONCLUSION The projection-based DPR-MoCo method helps to improve PET image quality of the myocardium without the need for external devices for motion tracking.
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Affiliation(s)
- Martin Lyngby Lassen
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
- Artificial Intelligence in Medicine program, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Alexander Berger
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Engineering and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Division of Nuclear Medicine, Department of Biomedical Engineering and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Florian Büther
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Engineering and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jacobo Cal-González
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Bing R, Loganath K, Adamson P, Newby D, Moss A. Non-invasive imaging of high-risk coronary plaque: the role of computed tomography and positron emission tomography. Br J Radiol 2020; 93:20190740. [PMID: 31821027 PMCID: PMC7465858 DOI: 10.1259/bjr.20190740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/12/2019] [Accepted: 11/30/2019] [Indexed: 11/09/2022] Open
Abstract
Despite recent advances, cardiovascular disease remains the leading cause of death globally. As such, there is a need to optimise our current diagnostic and risk stratification pathways in order to better deliver individualised preventative therapies. Non-invasive imaging of coronary artery plaque can interrogate multiple aspects of coronary atherosclerotic disease, including plaque morphology, anatomy and flow. More recently, disease activity is being assessed to provide mechanistic insights into in vivo atherosclerosis biology. Molecular imaging using positron emission tomography is unique in this field, with the potential to identify specific biological processes using either bespoke or re-purposed radiotracers. This review provides an overview of non-invasive vulnerable plaque detection and molecular imaging of coronary atherosclerosis.
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Affiliation(s)
- Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Krithika Loganath
- Wessex Heart Centre, University Hospital of Southampton, Southampton, UK
| | | | - David Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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9
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Høilund-Carlsen PF, Sturek M, Alavi A, Gerke O. Atherosclerosis imaging with 18F-sodium fluoride PET: state-of-the-art review. Eur J Nucl Med Mol Imaging 2019; 47:1538-1551. [PMID: 31773235 PMCID: PMC7188711 DOI: 10.1007/s00259-019-04603-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022]
Abstract
Purpose We examined the literature to elucidate the role of 18F-sodium fluoride (NaF)-PET in atherosclerosis. Methods Following a systematic search of PubMed/MEDLINE, Embase, and Cochrane Library included articles underwent subjective quality assessment with categories low, medium, and high. Of 2811 records, 1780 remained after removal of duplicates. Screening by title and abstract left 41 potentially eligible full-text articles, of which 8 (about the aortic valve (n = 1), PET/MRI feasibility (n = 1), aortic aneurysms (n = 1), or quantification methodology (n = 5)) were dismissed, leaving 33 published 2010–2012 (n = 6), 2013–2015 (n = 11), and 2016–2018 (n = 16) for analysis. Results They focused on coronary (n = 8), carotid (n = 7), and femoral arteries (n = 1), thoracic aorta (n = 1), and infrarenal aorta (n = 1). The remaining 15 studies examined more than one arterial segment. The literature was heterogeneous: few studies were designed to investigate atherosclerosis, 13 were retrospective, 9 applied both FDG and NaF as tracers, 24 NaF only. Subjective quality was low in one, medium in 13, and high in 19 studies. The literature indicates that NaF is a very specific tracer that mimics active arterial wall microcalcification, which is positively associated with cardiovascular risk. Arterial NaF uptake often presents before CT-calcification, tends to decrease with increasing density of CT-calcification, and appears, rather than FDG-avid foci, to progress to CT-calcification. It is mainly surface localized, increases with age with a wide scatter but without an obvious sex difference. NaF-avid microcalcification can occur in fatty streaks, but the degree of progression to CT-calcification is unknown. It remains unknown whether medical therapy influences microcalcification. The literature held no therapeutic or randomized controlled trials. Conclusion The literature was heterogeneous and with few clear cut messages. NaF-PET is a new approach to detect and quantify microcalcification in early-stage atherosclerosis. NaF uptake correlates with cardiovascular risk factors and appears to be a good measure of the body’s atherosclerotic burden, potentially suited also for assessment of anti-atherosclerotic therapy. Electronic supplementary material The online version of this article (10.1007/s00259-019-04603-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. .,Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Michael Sturek
- Department of Anatomy, Cell Biology, Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Marchesseau S, Totman JJ, Fadil H, Leek FAA, Chaal J, Richards M, Chan M, Reilhac A. Cardiac motion and spillover correction for quantitative PET imaging using dynamic MRI. Med Phys 2019; 46:726-737. [PMID: 30575047 DOI: 10.1002/mp.13345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Cardiac positron emission tomography/magnetic resonance imaging (PET/MRI) acquisition presents novel clinical applications thanks to the combination of viability and metabolic imaging (PET) and functional and structural imaging (MRI). However, the resolution of PET, as well as cardiac and respiratory motion in nongated cardiac imaging acquisition protocols, leads to a reduction in image quality and severe quantitative bias. Respiratory or cardiac motion is customarily addressed with gated reconstruction which results in higher noise. METHODS Inspired by a method that has been used in brain PET, a practical correction approach, designed to overcome these existing limitations for quantitative PET imaging, was developed and applied in the context of cardiac PET/MRI. The correction approach for PET data consists of computing the mean density map of each underlying moving region, as obtained with MRI, and translating them to the PET space taking into account the PET spatial and temporal resolution. Using these tissue density maps, the method then constructs a system of linear equations that models the activity recovery and cross-contamination coefficients, which can be solved for the true activity values. Physical and numerical cardiac phantoms were employed in order to quantify the proposed correction. The full correction pipeline was then used to assess differences in metabolic function between scar and healthy myocardium in eight patients with recent acute myocardial infarction using [11 C]-acetate. Data from ten additional patients, injected with [18 F]-FDG, were used to compare the method to the standard electrocardiography (ECG)-gated approach. RESULTS The proposed method resulted in better recovery (from 32% to 95% on the simulated phantom model) and less residual activity than the standard approach. Higher signal-to-noise and contrast-to-noise ratios than ECG-gating were also witnessed (Signal-to-noise ratio (SNR) increased from 2.92 to 5.24, contrast-to-noise ratio (CNR) increased from 62.9 to 145.9 when compared to a four-gate reconstruction). Finally, the relevance of this correction using [11 C]-acetate PET patient data, for which erroneous physiological conclusions could have been made based on the uncorrected data, was established as the correction led to the expected clinical results. CONCLUSIONS An efficient and simple method to correct for the quantitative biases in PET measurements caused by cardiac motion has been developed. Validation experiments using phantom and patient data showed improved accuracy and reliability with this approach when compared to simpler strategies such as gated acquisition or optimal regions of interest (ROI).
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Affiliation(s)
| | - John J Totman
- Clinical Imaging Research Centre, A*STAR-NUS, 117599, Singapore
| | - Hakim Fadil
- Clinical Imaging Research Centre, A*STAR-NUS, 117599, Singapore
| | | | - Jasper Chaal
- Clinical Imaging Research Centre, A*STAR-NUS, 117599, Singapore
| | - Mark Richards
- Cardiovascular Research Institute, National University of Singapore, 119228, Singapore.,Christchurch Heart Institute, University of Otago, Christchurch, 8140, New Zealand
| | - Mark Chan
- Department of Medicine, Yong Loo Lin SoM, National University of Singapore, 117597, Singapore
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Lassen ML, Kwiecinski J, Cadet S, Dey D, Wang C, Dweck MR, Berman DS, Germano G, Newby DE, Slomka PJ. Data-Driven Gross Patient Motion Detection and Compensation: Implications for Coronary 18F-NaF PET Imaging. J Nucl Med 2018; 60:830-836. [PMID: 30442755 DOI: 10.2967/jnumed.118.217877] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022] Open
Abstract
Patient motion degrades image quality, affecting the quantitative assessment of PET images. This problem affects studies of coronary lesions in which microcalcification processes are targeted. Coronary PET imaging protocols require scans of up to 30 min, introducing the risk of gross patient motion (GPM) during the acquisition. Here, we investigate the feasibility of an automated data-driven method for the detection of GPM during PET acquisition. Methods: Twenty-eight patients with stable coronary disease underwent a 30-min PET acquisition 1 h after the injection of 18F-sodium fluoride (18F-NaF) at 248 ± 10 MBq (mean ± SD) and then a coronary CT angiography scan. An automated data-driven GPM detection technique tracking the center of mass of the count rates for every 200 ms in the PET list-mode data was devised and evaluated. Two patient motion patterns were considered: sudden repositioning (motion of >0.5 mm within 3 s) and general repositioning (motion of >0.3 mm over 15 s or more). After the reconstruction of diastolic images, individual GPM frames with focal coronary uptake were coregistered in 3 dimensions, creating a GPM-compensated (GPMC) image series. Lesion motion was reported for all lesions with focal uptake. Relative differences in SUVmax and target-to-background ratio (TBR) between GPMC and non-GPMC (standard electrocardiogram-gated data) diastolic PET images were compared in 3 separate groups defined by the maximum motion observed in the lesion (<5, 5-10, and >10 mm). Results: A total of 35 18F-NaF-avid lesions were identified in 28 patients. An average of 3.5 ± 1.5 GPM frames were considered for each patient, resulting in an average frame duration of 7 ± 4 (range, 3-21) min. The mean per-patient motion was: 7 ± 3 mm (maximum, 13.7 mm). GPM correction increased SUVmax and TBR in all lesions with greater than 5 mm of motion. In lesions with 5-10 mm of motion (n = 15), SUVmax and TBR increased by 4.6% ± 5.6% (P = 0.02) and 5.8% ± 6.4% (P < 0.002), respectively. In lesions with greater than 10 mm of motion (n = 15), the SUVmax and TBR increased by 5.0% ± 5.3% (P = 0.009) and 11.5% ± 10.1% (P = 0.001), respectively. GPM correction led to the diagnostic reclassification of 3 patients (11%). Conclusion: GPM during coronary 18F-NaF PET imaging is common and may affect quantitative accuracy. Automated retrospective compensation of this motion is feasible and should be considered for coronary PET imaging.
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Affiliation(s)
| | - Jacek Kwiecinski
- Cedars-Sinai Medical Center, Los Angeles, California; and.,British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Chengjia Wang
- British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Guido Germano
- Cedars-Sinai Medical Center, Los Angeles, California; and
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Cedars-Sinai Medical Center, Los Angeles, California; and
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13
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Robson PM, Trivieri M, Karakatsanis NA, Padilla M, Abgral R, Dweck MR, Kovacic JC, Fayad ZA. Correction of respiratory and cardiac motion in cardiac PET/MR using MR-based motion modeling. Phys Med Biol 2018; 63:225011. [PMID: 30426968 DOI: 10.1088/1361-6560/aaea97] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac positron emission tomography (PET) imaging suffers from image blurring due to the constant motion of the heart that can impact interpretation. Hybrid PET/magnetic resonance (MR) has the potential to use radiation-free MR imaging to correct for the effects of cardio-respiratory motion in the PET data, improving qualitative and quantitative PET imaging in the heart. The purpose of this study was (i) to implement a MR image-based motion-corrected PET/MR method and (ii) to perform a proof-of-concept study of quantitative myocardial PET data in patients. The proposed method takes reconstructions of respiratory and cardiac gated PET data and applies spatial transformations to a single reference frame before averaging to form a single motion-corrected PET (MC-PET) image. Motion vector fields (MVFs) describing the transformations were derived from affine or non-rigid registration of respiratory and cardiac gated MR data. Eight patients with suspected cardiac sarcoidosis underwent cardiac PET/MR imaging after injection of 5 MBq kg-1 of 18F-fluorodeoxyglucose (18F-FDG). Myocardial regions affected by motion were identified by expert readers within which target-to-background ratios (TBR) and contrast-to-noise ratios (CNR) were measured on non-MC-non-gated, MC-PET, and double respiratory and cardiac gated PET images. Paired t-tests were used to determine statistical differences in quantitative uptake-measures between the different types of PET images. MC-PET images showed less blurring compared to non-MC-non-gated PET and tracer activity qualitatively aligned better with the underlying myocardial anatomy when fused with MR. TBR and CNR were significantly greater for MC-PET (2.8 ± 0.9; 21 ± 22) compared to non-MC-non-gated PET (2.4 ± 0.9, p = 0.0001; 15 ± 13, p = 0.02), while TBR was lower and CNR greater compared to double-gated PET (3.2 ± 0.9, p = 0.04; 6 ± 3, p = 0.004). This study demonstrated in a patient cohort that motion-corrected (MC) cardiac PET/MR is feasible using a retrospective MR image-based method and that improvement in TBR and CNR are achievable. MC PET/MR holds promise for improving interpretation and quantification in cardiac PET imaging.
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Affiliation(s)
- Philip M Robson
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, New York, NY 10029, United States of America. Author to whom any correspondence should be addressed
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Kolbitsch C, Neji R, Fenchel M, Mallia A, Marsden P, Schaeffter T. Respiratory-resolved MR-based attenuation correction for motion-compensated cardiac PET-MR. ACTA ACUST UNITED AC 2018; 63:135008. [DOI: 10.1088/1361-6560/aaca15] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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