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Baldetti L, Busnardo E, Pazzanese V, Ricchetti G, Barone G, Sacchi S, Calvo F, Gramegna M, Pieri M, Ingallina G, Camici PG, Ajello S, Scandroglio AM. Myocardial viability assessment during Impella support with 18-fluorodesoxyglucose PET imaging. ESC Heart Fail 2024. [PMID: 39239887 DOI: 10.1002/ehf2.15053] [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: 05/29/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024] Open
Abstract
Formal assessment of myocardial viability (MV) is challenging in acute myocardial infarction-related cardiogenic shock (AMI-CS) patients receiving Impella mechanical circulatory support, as the cardiac magnetic resonance gold standard technique is not feasible due to the metallic components of the device. 18-fluorodesoxyglucose metabolic myocardial positron emission tomography (18FDG-PET) may represent a valid and feasible alternative to obtain semi-quantitative and objective evidence of MV during Impella support. We hereby report the first series of sequential AMI-CS patients who received 18FDG-PET scanning to assess MV during Impella support to demonstrate the safety and feasibility of this approach. In this cohort no adverse events occurred during 18FDG-PET scans, and all images were of excellent quality. This study provides a pragmatic guidance on how to perform this imaging modality during Impella support and finally confirms the safety and feasibility of this advanced imaging method also in this vulnerable cohort of patients.
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Affiliation(s)
- Luca Baldetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Busnardo
- Nuclear Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Ricchetti
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Barone
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Sacchi
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Calvo
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Gramegna
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Pieri
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Guido Camici
- Cardiovascualr Research Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ajello
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Xu D, Zhang J, Liu B, Fu D, Li J, Fan L. Determination of viable myocardium through delayed enhancement cardiac magnetic resonance imaging combined with 18F-FDG PET myocardial perfusion/metabolic imaging before CABG. Int J Cardiovasc Imaging 2024; 40:887-895. [PMID: 38265540 PMCID: PMC11052819 DOI: 10.1007/s10554-024-03057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Study aims to investigate the consistency of delayed enhancement cardiac magnetic resonance imaging (DE-CMR) and 18F-FDG PET myocardial imaging in evaluating myocardial viability before CABG. METHODS The study analyzed data from 100 patients who were examined with DE-CMR, PET imaging, and echocardiography before and after CABG. All subjects were followed up for 6-12 month post- CABG. RESULTS DE-CMR and PET imaging have high consistency (90.1%; Kappa value = 0.71, p < 0.01) in determining myocardial viability. The degree of delayed enhancement was negatively correlated with the improvement in myocardial contractile function in this segment after revascularization (P < 0.001). The ratio of scarred myocardial segments and total DE score was significantly lower in the improvement group than non-improvement group. Multivariate regression identified that hibernating myocardium (OR = 1.229, 95%CI: 1.053-1.433, p = 0.009) was influencing factor of LVEF improvement after CABG. CONCLUSION Both imaging techniques are consistent in evaluating myocardial viability. Detecting the number of hibernating myocardium by PET is also important to predict the left heart function improvement after CABG.
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Affiliation(s)
- Dongsheng Xu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Jiwang Zhang
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Bing Liu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Donghai Fu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Jianming Li
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Lijuan Fan
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China.
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Rischpler C, Seifert R. Combined PET and MRI for the masses! : At least for the cardiac ones. J Nucl Cardiol 2022; 29:1518-1519. [PMID: 34935109 PMCID: PMC9351608 DOI: 10.1007/s12350-021-02881-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Comparative Analysis of Myocardial Viability Multimodality Imaging in Patients with Previous Myocardial Infarction and Symptomatic Heart Failure. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030368. [PMID: 35334543 PMCID: PMC8955633 DOI: 10.3390/medicina58030368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
Background and Objectives: To compare the accuracy of multimodality imaging (myocardial perfusion imaging with single-photon emission computed tomography (SPECT MPI), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), and cardiovascular magnetic resonance (CMR) in the evaluation of left ventricle (LV) myocardial viability for the patients with the myocardial infarction (MI) and symptomatic heart failure (HF). Materials and Methods: 31 consecutive patients were included in the study prospectively, with a history of previous myocardial infarction, symptomatic HF (NYHA) functional class II or above, reduced ejection fraction (EF) ≤ 40%. All patients had confirmed atherosclerotic coronary artery disease (CAD), but conflicting opinions regarding the need for percutaneous intervention due to the suspected myocardial scar tissue. All patients underwent transthoracic echocardiography (TTE), SPECT MPI, 18F-FDG PET, and CMR with late gadolinium enhancement (LGE) examinations. Quantification of myocardial viability was assessed in a 17-segment model. All segments that were described as non-viable (score 4) by CMR LGE and PET were compared. The difference of score between CMR and PET we named reversibility score. According to this reversibility score, patients were divided into two groups: Group 1, reversibility score > 10 (viable myocardium with a chance of functional recovery after revascularization); Group 2, reversibility score ≤ 10 (less viable myocardium when revascularisation remains questionable). Results: 527 segments were compared in total. A significant difference in scores 1, 2, 3 group, and score 4 group was revealed between different modalities. CMR identified “non-viable” myocardium in 28.1% of segments across all groups, significantly different than SPECT in 11.8% PET in 6.5% Group 1 (viable myocardium group) patients had significantly higher physical tolerance (6 MWT (m) 3892 ± 94.5 vs. 301.4 ± 48.2), less dilated LV (LVEDD (mm) (TTE) 53.2 ± 7.9 vs. 63.4 ± 8.9; MM (g) (TTE) 239.5 ± 85.9 vs. 276.3 ± 62.7; LVEDD (mm) (CMR) 61.7 ± 8.1 vs. 69.0 ± 6.1; LVEDDi (mm/m2) (CMR) 29.8 ± 3.7 vs. 35.2 ± 3.1), significantly better parameters of the right heart (RV diameter (mm) (TTE) 33.4 ± 6.9 vs. 38.5 ± 5.0; TAPSE (mm) (TTE) 18.7 ± 2.0 vs. 15.2 ± 2.0), better LV SENC function (LV GLS (CMR) −14.3 ± 2.1 vs. 11.4 ± 2.9; LV GCS (CMR) −17.2 ± 4.6 vs. 12.7 ± 2.6), smaller size of involved myocardium (infarct size (%) (CMR) 24.5 ± 9.6 vs. 34.8 ± 11.1). Good correlations were found with several variables (LVEDD (CMR), LV EF (CMR), LV GCS (CMR)) with a coefficient of determination (R2) of 0.72. According to the cut-off values (LVEDV (CMR) > 330 mL, infarct size (CMR) > 26%, and LV GCS (CMR) < −15.8), we performed prediction of non-viable myocardium (reversibility score < 10) with the overall percentage of 80.6 (Nagelkerke R2 0.57). Conclusions: LGE CMR reveals a significantly higher number of scars, and the FDG PET appears to be more optimistic in the functional recovery prediction. Moreover, using exact imaging parameters (LVEDV (CMR) > 330 mL, infarct size (CMR) > 26% and LV GCS (CMR) < −15.8) may increase sensitivity and specificity of LGE CMR for evaluation of non-viable myocardium and lead to a better clinical solution (revascularization vs. medical treatment) even when viability is low in LGE CMR, and FDG PET is not performed.
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Kiko T, Yokokawa T, Misaka T, Masuda A, Yoshihisa A, Yamaki T, Kunii H, Nakazato K, Takeishi Y. Myocardial viability with chronic total occlusion assessed by hybrid positron emission tomography/magnetic resonance imaging. J Nucl Cardiol 2021; 28:2335-2342. [PMID: 32002845 DOI: 10.1007/s12350-020-02041-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The present study was performed to compare the relationship of 18F-fluorodeoxyglucose (FDG) uptake and late gadolinium enhancement (LGE) transmurality with the improvement of left ventricular function in patients with coronary chronic total occlusion (CTO) assessed by hybrid FDG positron emission tomography (PET)/magnetic resonance imaging (MRI). METHODS Thirty-eight consecutive patients with CTO underwent FDG PET/MRI. Twenty-three patients then underwent percutaneous coronary intervention (PCI), and the final study population comprised 15 patients who underwent both initial and follow-up MRI. The degree of wall motion abnormality in each of the 17 myocardial segments was evaluated based on the extent of wall thickening on cine MRI using a 5-point scale. RESULTS Among all 646 myocardial segments at baseline, FDG uptake significantly decreased as the transmurality of LGE is advanced. Of the 15 patients who underwent PCI, 152 segments showed wall motion abnormalities at baseline. The functional recovery of the wall motion abnormality of the PET-viable/MRI-viable segments was highest, and that of the PET-nonviable/MRI-nonviable segments was lowest. There were no differences in functional recovery between the PET-viable/MRI-nonviable and PET-nonviable/MRI-viable segments. CONCLUSION Simultaneous assessment of FDG and LGE using a hybrid PET/MRI system can help to predict functional recovery after PCI in patients with CTO.
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Affiliation(s)
- Takatoyo Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan.
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Atsuro Masuda
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
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7
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Mpanya D, Ayeni A, More S, Hadebe B, Sathekge M, Tsabedze N. The clinical utility of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography in guiding myocardial revascularisation. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00454-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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8
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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Khalaf S, Al-Mallah MH. Fluorodeoxyglucose Applications in Cardiac PET: Viability, Inflammation, Infection, and Beyond. Methodist Debakey Cardiovasc J 2020; 16:122-129. [PMID: 32670472 DOI: 10.14797/mdcj-16-2-122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With its high temporal and spatial resolution and relatively low radiation exposure, positron emission tomography (PET) is increasingly being used in the management of cardiac patients, particularly those with inflammatory cardiomyopathies such as sarcoidosis. This review discusses the role of PET imaging in assessing myocardial viability, inflammatory cardiomyopathies, and endocarditis; describes the different protocols needed to acquire images for specific imaging tests; and examines imaging interpretation for each image dataset-including identification of the mismatch defect in viability imaging, which is associated with significant improvement in LV function after revascularization. We also review the role of fluorodeoxyglucose PET in cardiac sarcoidosis diagnosis, the complementary role of magnetic resonance imaging in inflammatory cardiomyopathy, and the emerging use of cardiac PET in prosthetic valve endocarditis.
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Affiliation(s)
- Shaden Khalaf
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mouaz H Al-Mallah
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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10
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Abstract
Cardiac PET/MR imaging is an integrated imaging approach that requires less radiation than PET/computed tomography and combines the high spatial resolution and morphologic data from MR imaging with the physiologic information from PET. This hybrid approach has the potential to improve the diagnostic and prognostic evaluation of several cardiovascular conditions, such as ischemic heart disease, infiltrative diseases such as sarcoidosis, acute and chronic myocarditis, and cardiac masses. Herein, the authors discuss the strengths of PET and MR imaging in several cardiovascular conditions; the challenges and potential; and the current data on the application of this powerful hybrid imaging modality.
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Affiliation(s)
- Rhanderson Cardoso
- Division of Cardiology, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 547, Baltimore, MD 21287, USA
| | - Thorsten M Leucker
- Division of Cardiology, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 547, Baltimore, MD 21287, USA.
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11
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Manabe O, Oyama-Manabe N, Tamaki N. Positron emission tomography/MRI for cardiac diseases assessment. Br J Radiol 2020; 93:20190836. [PMID: 32023123 DOI: 10.1259/bjr.20190836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Functional imaging tools have emerged in the last few decades and are increasingly used to assess the function of the human heart in vivo. Positron emission tomography (PET) is used to evaluate myocardial metabolism and blood flow. Magnetic resonance imaging (MRI) is an essential tool for morphological and functional evaluation of the heart. In cardiology, PET is successfully combined with CT for hybrid cardiac imaging. The effective integration of two imaging modalities allows simultaneous data acquisition combining functional, structural and molecular imaging. After PET/CT has been successfully accepted for clinical practices, hybrid PET/MRI is launched. This review elaborates the current evidence of PET/MRI in cardiovascular imaging and its expected clinical applications for a comprehensive assessment of cardiovascular diseases while highlighting the advantages and limitations of this hybrid imaging approach.
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Affiliation(s)
- Osamu Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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12
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Tzolos E, Andrews JPM, Dweck MR. Aortic valve stenosis-multimodality assessment with PET/CT and PET/MRI. Br J Radiol 2020; 93:20190688. [PMID: 31647323 PMCID: PMC7465843 DOI: 10.1259/bjr.20190688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aortic valve disease is the most common form of heart valve disease in developed countries and a growing healthcare burden with an ageing population. Transthoracic and transoesophageal echocardiography remains central to the diagnosis and surveillance of patients with aortic stenosis, providing gold standard assessments of valve haemodynamics and myocardial performance. However, other multimodality imaging techniques are being explored for the assessment of aortic stenosis, including combined PET/CT and PET/MR. Both approaches provide unique information with respect to disease activity in the valve alongside more conventional anatomic assessments of the valve and myocardium in this condition. This review investigates the emerging use of PET/CT and PET/MR to assess patients with aortic stenosis, examining how the complementary data provided by each modality may be used for research applications and potentially in future clinical practice.
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Affiliation(s)
- Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jack PM Andrews
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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13
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Wang X, Yang B, Moody JB, Tang J. Improved myocardial perfusion PET imaging using artificial neural networks. Phys Med Biol 2020; 65:145010. [PMID: 32244234 DOI: 10.1088/1361-6560/ab8687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial perfusion (MP) PET imaging plays a key role in risk assessment and stratification of patients with coronary artery disease. In this work, we proposed a patch-based artificial neural network (ANN) fusion approach that integrates information from the ML and the post-smoothed ML reconstruction to improve MP PET imaging. The proposed method was applied to images reconstructed from different noise levels to enhance quantification and task-based MP defect detection. Using the XCAT phantom, we simulated three MP PET imaging cases, one with normal perfusion and the other two with non-transmural and transmural regionally reduced perfusion of the left ventricular (LV) myocardium. The proposed ANN fusion technique was quantitatively evaluated in terms of the noise versus bias and noise versus contrast tradeoff, and compared with the post-smoothed ML reconstruction. Using the channelized Hotelling observer, we evaluated the detectability of the non-transmural and transmural defects through the receiver operating characteristic analysis. The quantitative results demonstrated that the ANN enhancement method reduced bias and improved contrast while reaching comparable noise to what the post-smoothed ML reconstruction achieved. Moreover, the ANN fusion technique significantly improved the defect detectability of both the non-transmural and transmural defects. In addition to the simulation study, we further evaluated the proposed method using patient data. Compared with the post-smoothed ML reconstruction, the ANN fusion improved the tradeoff between noise and the mean value on the LV myocardium, indicating its potential clinical application in MP PET imaging.
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Affiliation(s)
- Xinhui Wang
- Department of Electrical and Computer Engineering, Oakland University, Rochester, MI, United States of America
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14
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Winkler J, Lukovic D, Mester-Tonczar J, Zlabinger K, Gugerell A, Pavo N, Jakab A, Szankai Z, Traxler D, Müller C, Spannbauer A, Riesenhuber M, Hašimbegović E, Dawkins J, Zimmermann M, Ankersmit HJ, Marbán E, Gyöngyösi M. Quantitative Hybrid Cardiac [ 18F]FDG-PET-MRI Images for Assessment of Cardiac Repair by Preconditioned Cardiosphere-Derived Cells. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 18:354-366. [PMID: 32671138 PMCID: PMC7341058 DOI: 10.1016/j.omtm.2020.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
Cardiosphere-derived cells (CDCs) are progenitor cells derived from heart tissue and have shown promising results in preclinical models. APOSEC, the secretome of irradiated peripheral blood mononuclear cells, has decreased infarct size in acute and chronic experimental myocardial infarction (MI). We enhanced the effect of CDCs with APOSEC preconditioning (apoCDC) and investigated the reparative effect in a translational pig model of reperfused MI. Supernatants of CDCs, assessed by proteomic analysis, revealed reduced production of extracellular matrix proteins after in vitro APOSEC preconditioning. In a porcine model of catheter-based reperfused anterior acute MI (AMI), CDCs with (apoCDC, n = 8) or without APOSEC preconditioning (CDC, n = 6) were infused intracoronary, 15 min after the start of reperfusion. Untreated AMI animals (n = 7) and sham procedures (n = 5) functioned as controls. 2-deoxy-2-(18 F)-fluoro-D-glucose-positron emission tomography-magnetic resonance imaging ([18F]FDG-PET-MRI), with late enhancement after 1 month, showed reduced scar volume and lower transmurality of the infarcted area in CDC and apoCDC compared to AMI controls. Segmental quantitative PET images displayed indicated more residual viability in apoCDC. The left-ventricle (LV) ejection fraction was improved nonsignificantly to 45.8% ± 8.6% for apoCDC and 43.5% ± 7.1% for CDCs compared to 38.5% ± 4.4% for untreated AMI. Quantitative hybrid [18F]FDG-PET-MRI demonstrated improved metabolic and functional recovery after CDC administration, whereas apoCDCs induced preservation of viability of the infarcted area.
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Affiliation(s)
- Johannes Winkler
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dominika Lukovic
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Katrin Zlabinger
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alfred Gugerell
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Noemi Pavo
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - András Jakab
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Center for MR-Research, University Children's Hospital Zurich, Steinwiesstrasse 7e, 80cb Zurich, Switzerland
| | - Zsuzsanna Szankai
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Denise Traxler
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Claudia Müller
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Ena Hašimbegović
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - James Dawkins
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Eduardo Marbán
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
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15
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Vitadello T, Kunze KP, Nekolla SG, Langwieser N, Bradaric C, Weis F, Cassese S, Fusaro M, Hapfelmeier A, Lewalter T, Schwaiger M, Kastrati A, Laugwitz KL, Rischpler C, Ibrahim T. Hybrid PET/MR imaging for the prediction of left ventricular recovery after percutaneous revascularisation of coronary chronic total occlusions. Eur J Nucl Med Mol Imaging 2020; 47:3074-3083. [PMID: 32472438 PMCID: PMC7680332 DOI: 10.1007/s00259-020-04877-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/19/2020] [Indexed: 01/12/2023]
Abstract
Purpose To evaluate myocardial viability assessment with hybrid 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/magnetic resonance imaging ([18F]FDG-PET/MR) in predicting left ventricular (LV) wall motion recovery after percutaneous revascularisation of coronary chronic total occlusion (CTO). Methods and results Forty-nine patients with CTO and corresponding wall motion abnormality (WMA) underwent [18F]FDG-PET/MR imaging for viability assessment prior to percutaneous revascularisation. After 3–6 months, 23 patients underwent follow-up MR to evaluate wall motion recovery. In total, 124 segments were assigned to the CTO territories, while 80 segments displayed impaired wall motion. Of these, 68% (54) were concordantly viable in PET and MR; conversely, only 2 segments (2%) were assessed non-viable by both modalities. However, 30% showed a discordant viability pattern, either PET non-viable/MR viable (3 segments, 4%) or PET viable/MR non-viable (21 segments, 26%), and the latter revealed a significant wall motion improvement at follow-up (p = 0.033). Combined imaging by [18F]FDG-PET/MR showed a fair accuracy in predicting myocardial recovery after CTO revascularisation (PET/MR area under ROC curve (AUC) = 0.72, p = 0.002), which was superior to LGE-MR (AUC = 0.66) and [18F]FDG-PET (AUC = 0.58) alone. Conclusion Hybrid PET/MR imaging prior to CTO revascularisation predicts more accurately the recovery of dysfunctional myocardium than PET or MR alone. Its complementary information may identify regions of viable myocardium with increased potential for functional recovery.
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Affiliation(s)
- Teresa Vitadello
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Karl P Kunze
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nicolas Langwieser
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Christian Bradaric
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Florian Weis
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thorsten Lewalter
- Osypka Herzzentrum, Internistisches Klinikum München Süd, Munich, Germany
| | - Markus Schwaiger
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christoph Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
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16
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Calcagno C, Fayad ZA. Clinical imaging of cardiovascular inflammation. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2020; 64:74-84. [PMID: 32077666 DOI: 10.23736/s1824-4785.20.03228-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular disease due to atherosclerosis is the number one cause of morbidity and mortality worldwide. In the past twenty years, compelling preclinical and clinical data have indicated that a maladaptive inflammatory response plays a crucial role in the development of atherosclerosis initiation and progression in the vasculature, all the way to the onset of life-threatening cardiovascular events. Furthermore, inflammation is key to heart and brain damage and healing after myocardial infarction or stroke. Recent evidence indicates that this interplay between the vasculature, organs target of ischemia and the immune system is mediated by the activation of hematopoietic organs (bone marrow and spleen). In this evolving landscape, non-invasive imaging is becoming more and more essential to support either mechanistic preclinical studies to investigate the role of inflammation in cardiovascular disease (CVD), or as a translational tool to quantify inflammation in the cardiovascular system and hematopoietic organs in patients. In this review paper, we will describe the clinical applications of non-invasive imaging to quantify inflammation in the vasculature, infarcted heart and brain, and hematopoietic organs in patients with cardiovascular disease, with specific focus on [18F]FDG PET and other novel inflammation-specific radiotracers. Furthermore, we will briefly describe the most recent clinical applications of other imaging techniques such as MRI, SPECT, CT, CEUS and OCT in this arena.
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Affiliation(s)
- Claudia Calcagno
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA - .,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Kiuchi K, Fukuzawa K, Nogami M, Watanabe Y, Takami M, Mori S, Shimoyama S, Negi N, Kyotani K, Hirata KI. Visualization of Inflammation After Cryoballoon Ablation in Atrial Fibrillation Patients - Protocol for Proof-of-Concept Feasibility Trial. Circ Rep 2020; 1:149-152. [PMID: 33693130 PMCID: PMC7890275 DOI: 10.1253/circrep.cr-19-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background:
Atrial fibrosis and inflammation play important roles in perpetuating and initiating atrial fibrillation (AF). Although the fibrotic area can be visualized as a delayed enhancement area on late gadolinium enhancement magnetic resonance imaging (LGE-MRI), atrial inflammation has not yet been visualized on any imaging modality. We describe the protocol for a feasibility study to visualize atrial inflammation on positron emission tomography/MRI (PET/MRI). Methods and Results:
This is a single-arm, prospective, open-label proof-of concept trial, involving AF patients after cryoballoon ablation (CBA). A total of 30 paroxysmal AF patients will be enrolled and undergo simultaneous PET/MRI for the assessment of regional 18F-fluorodeoxyglucose (18F-FDG) uptake 1 day after the CBA. Furthermore, LGE-MRI will be performed before CBA, and at 1 and 4 weeks after assessing the regional LGE area. The main outcome measures will be (1) the feasibility of imaging inflammation in the left atrium on PET/MRI; and (2) the safety of the intervention. Conclusions:
There are few data on the visualization of atrial inflammation using PET/MRI. Establishing the visualization methodology will contribute to elucidating the fundamental histopathologic findings of the progress to fibrosis, and to the planning and execution of a larger definitive trial to test the usefulness of PET/MRI.
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Affiliation(s)
- Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Kobe Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Kobe Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Graduate School of Medicine Kobe Japan
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine Kobe Japan
| | - Mitsuru Takami
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Kobe Japan
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Kobe Japan
| | - Shinsuke Shimoyama
- Department of Radiology, Kobe University Graduate School of Medicine Kobe Japan
| | - Noriyuki Negi
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe University Hospital Kobe Japan
| | - Katsusuke Kyotani
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe University Hospital Kobe Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Kobe Japan
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18
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Cho SG, Jabin Z, Lee C, Bom HHS. The tools are ready, are we? J Nucl Cardiol 2019; 26:557-560. [PMID: 28828735 DOI: 10.1007/s12350-017-1032-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Zeenat Jabin
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
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19
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Rischpler C, Nekolla SG, Heusch G, Umutlu L, Rassaf T, Heusch P, Herrmann K, Nensa F. Cardiac PET/MRI-an update. Eur J Hybrid Imaging 2019; 3:2. [PMID: 34191143 PMCID: PMC8212244 DOI: 10.1186/s41824-018-0050-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/17/2018] [Indexed: 12/21/2022] Open
Abstract
It is now about 8 years since the first whole-body integrated PET/MRI has been installed. First, reports on technical characteristics and system performance were published. Early after, reports on the first use of PET/MRI in oncological patients were released. Interestingly, the first article on the application in cardiology was a review article, which was published before the first original article was put out. Since then, researchers have gained a lot experience with the PET/MRI in various cardiovascular diseases and an increasing number on auspicious indications is appearing. In this review article, we give an overview on technical updates within these last years with potential impact on cardiac imaging and summarize those scenarios where PET/MRI plays a pivotal role in cardiovascular medicine.
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Affiliation(s)
- C Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - S G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart alliance, Munich, Germany
| | - G Heusch
- Institute for Pathophysiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - L Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - T Rassaf
- Department of Cardiology and Vascular Medicine, University Hospital Essen, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - P Heusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - K Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - F Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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20
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Nensa F, Bamberg F, Rischpler C, Menezes L, Poeppel TD, la Fougère C, Beitzke D, Rasul S, Loewe C, Nikolaou K, Bucerius J, Kjaer A, Gutberlet M, Prakken NH, Vliegenthart R, Slart RHJA, Nekolla SG, Lassen ML, Pichler BJ, Schlosser T, Jacquier A, Quick HH, Schäfers M, Hacker M. Hybrid cardiac imaging using PET/MRI: a joint position statement by the European Society of Cardiovascular Radiology (ESCR) and the European Association of Nuclear Medicine (EANM). Eur Radiol 2018; 28:4086-4101. [PMID: 29717368 PMCID: PMC6132726 DOI: 10.1007/s00330-017-5008-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/01/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
Positron emission tomography (PET) and magnetic resonance imaging (MRI) have both been used for decades in cardiovascular imaging. Since 2010, hybrid PET/MRI using sequential and integrated scanner platforms has been available, with hybrid cardiac PET/MR imaging protocols increasingly incorporated into clinical workflows. Given the range of complementary information provided by each method, the use of hybrid PET/MRI may be justified and beneficial in particular clinical settings for the evaluation of different disease entities. In the present joint position statement, we critically review the role and value of integrated PET/MRI in cardiovascular imaging, provide a technical overview of cardiac PET/MRI and practical advice related to the cardiac PET/MRI workflow, identify cardiovascular applications that can potentially benefit from hybrid PET/MRI, and describe the needs for future development and research. In order to encourage its wide dissemination, this article is freely accessible on the European Radiology and European Journal of Hybrid Imaging web sites. KEY POINTS • Studies and case-reports indicate that PET/MRI is a feasible and robust technology. • Promising fields of application include a variety of cardiac conditions. • Larger studies are required to demonstrate its incremental and cost-effective value. • The translation of novel radiopharmaceuticals and MR-sequences will provide exciting new opportunities.
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Affiliation(s)
- Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Christoph Rischpler
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Leon Menezes
- UCL Institute of Nuclear Medicine, and NIHR, University College London Hospitals Biomedical Research Centre, 5th Floor Tower, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Thorsten D Poeppel
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Christian la Fougère
- Nuklearmedizin und Klinische Molekulare Bildgebung, Otfried-Müller-Straße 14, 72076, Tübingen, Germany
| | - Dietrich Beitzke
- Department of Bioimaging and Image-Guided Therapy, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sazan Rasul
- Department of Radiology and Nuclear Medicine, Medical University Vienna, Währinger Gürtel 18-20, Floor 5L, 1090, Vienna, Austria
| | - Christian Loewe
- Department of Bioimaging and Image-Guided Therapy, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Jan Bucerius
- Maastricht Oncology Centre, Medical University Maastricht, P. Debyelaan 25, 6229 HX, Maastrich, Netherlands
| | - Andreas Kjaer
- Section of Endocrinology Research, University of Copenhagen, Panum Instituttet, Blegdamsvej 3, 2200, 12.3, Copenhagen N, Denmark
| | - Matthias Gutberlet
- Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Niek H Prakken
- University Medical Center Groningen, Department of Radiology, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Rozemarijn Vliegenthart
- University Medical Center Groningen, Department of Radiology, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, Netherlands
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Martin L Lassen
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, AKH-4L Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernd J Pichler
- Abteilung für Präklinische Bildgebung und Radiopharmazie, University of Tübingen, Röntgenweg 13, 72026, Tübingen, Germany
| | - Thomas Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Alexis Jacquier
- Department of Cardiovascular and Thoracic Radiology, Assistance Publique Hopitaux de Marseille; University of Aix-Marseille, 264 rue Saint Pierre, 13385, Marseille, France
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine and European Institute for Molecular Imaging (EIMI), University of Münster, Albert-Schweitzer-Campus 1, building A1, 48149, Münster, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Währinger Gürtel 18-20, Floor 5L, 1090, Vienna, Austria
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21
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Munoz C, Kunze KP, Neji R, Vitadello T, Rischpler C, Botnar RM, Nekolla SG, Prieto C. Motion-corrected whole-heart PET-MR for the simultaneous visualisation of coronary artery integrity and myocardial viability: an initial clinical validation. Eur J Nucl Med Mol Imaging 2018; 45:1975-1986. [PMID: 29754161 PMCID: PMC6132558 DOI: 10.1007/s00259-018-4047-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/02/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Cardiac PET-MR has shown potential for the comprehensive assessment of coronary heart disease. However, image degradation due to physiological motion remains a challenge that could hinder the adoption of this technology in clinical practice. The purpose of this study was to validate a recently proposed respiratory motion-corrected PET-MR framework for the simultaneous visualisation of myocardial viability (18F-FDG PET) and coronary artery anatomy (coronary MR angiography, CMRA) in patients with chronic total occlusion (CTO). METHODS A cohort of 14 patients was scanned with the proposed PET-CMRA framework. PET and CMRA images were reconstructed with and without the proposed motion correction approach for comparison purposes. Metrics of image quality including visible vessel length and sharpness were obtained for CMRA for both the right and left anterior descending coronary arteries (RCA, LAD), and relative increase in 18F-FDG PET signal after motion correction for standard 17-segment polar maps was computed. Resulting coronary anatomy by CMRA and myocardial integrity by PET were visually compared against X-ray angiography and conventional Late Gadolinium Enhancement (LGE) MRI, respectively. RESULTS Motion correction increased CMRA visible vessel length by 49.9% and 32.6% (RCA, LAD) and vessel sharpness by 12.3% and 18.9% (RCA, LAD) on average compared to uncorrected images. Coronary lumen delineation on motion-corrected CMRA images was in good agreement with X-ray angiography findings. For PET, motion correction resulted in an average 8% increase in 18F-FDG signal in the inferior and inferolateral segments of the myocardial wall. An improved delineation of myocardial viability defects and reduced noise in the 18F-FDG PET images was observed, improving correspondence to subendocardial LGE-MRI findings compared to uncorrected images. CONCLUSION The feasibility of the PET-CMRA framework for simultaneous cardiac PET-MR imaging in a short and predictable scan time (~11 min) has been demonstrated in 14 patients with CTO. Motion correction increased visible length and sharpness of the coronary arteries by CMRA, and improved delineation of the myocardium by 18F-FDG PET, resulting in good agreement with X-ray angiography and LGE-MRI.
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Affiliation(s)
- Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Karl P Kunze
- Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare, Frimley, UK
| | - Teresa Vitadello
- Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Christoph Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Escuela de Ingenieria, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Stephan G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.) partner site Munich Heart Alliance, Munich, Germany
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
- Escuela de Ingenieria, Pontificia Universidad Catolica de Chile, Santiago, Chile
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22
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Hunold P, Jakob H, Erbel R, Barkhausen J, Heilmaier C. Accuracy of myocardial viability imaging by cardiac MRI and PET depending on left ventricular function. World J Cardiol 2018; 10:110-118. [PMID: 30344958 PMCID: PMC6189071 DOI: 10.4330/wjc.v10.i9.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/28/2018] [Accepted: 08/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging (CMR) compared to [18F]-fluorodeoxyglucose (FDG)- positron emission tomography (PET) depending on left ventricular (LV) function.
METHODS One-hundred-five patients with known obstructive coronary artery disease (CAD) and anticipated coronary revascularization were included in the study and examined by CMR on a 1.5T scanner. The CMR protocol consisted of cine-sequences for function analysis and late gadolinium enhancement (LGE) imaging for viability assessment in 8 mm long and contiguous short axis slices. All patients underwent PET using [18F]-FDG. Myocardial scars were rated in both CMR and PET on a segmental basis by a 4-point-scale: Score 1 = no LGE, normal FDG-uptake; score 2 = LGE enhancement < 50% of wall thickness, reduced FDG-uptake ( ≥ 50% of maximum); score 3 = LGE ≥ 50%, reduced FDG-uptake (< 50% of maximum); score 4 = transmural LGE, no FDG-uptake. Segments with score 1 and 2 were categorized “viable”, scores 3 and 4 were categorized as “non-viable”. Patients were divided into three groups based on LV function as determined by CMR: Ejection fraction (EF), < 30%: n = 45; EF: 30%-50%: n = 44; EF > 50%: n = 16). On a segmental basis, the accuracy of CMR in detecting myocardial scar was compared to PET in the total collective and in the three different patient groups.
RESULTS CMR and PET data of all 105 patients were sufficient for evaluation and 5508 segments were compared in total. In all patients, CMR detected significantly more scars (score 2-4) than PET: 45% vs 40% of all segments (P < 0.0001). In the different LV function groups, CMR found more scar segments than PET in subjects with EF< 30% (55% vs 46%; P < 0.0001) and EF 30%-50% (44% vs 40%; P < 0.005). However, CMR revealed less scars than PET in patients with EF > 50% (15% vs 23%; P < 0.0001). In terms of functional improvement estimation, i.e., expected improvement after revascularization, CMR identified “viable” segments (score 1 and 2) in 72% of segments across all groups, PET in 80% (P < 0.0001). Also in all LV function subgroups, CMR judged less segments viable than PET: EF < 30%, 66% vs 75%; EF = 30%-50%, 72% vs 80%; EF > 50%, 91% vs 94%.
CONCLUSION CMR and PET reveal different diagnostic accuracy in myocardial viability assessment depending on LV function state. CMR, in general, is less optimistic in functional recovery prediction.
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Affiliation(s)
- Peter Hunold
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck 23538, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, University Hospital Essen, Essen 45122, Germany
| | - Raimund Erbel
- Department of Cardiology, West German Heart Center, University of Duisburg-Essen, University Hospital Essen, Essen 45122, Germany
| | - Jörg Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck 23538, Germany
| | - Christina Heilmaier
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli, Zürich 8063, Switzerland
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23
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Qin J, Zhou S, Li Z, Chen Y, Qin Q, Ai T. Combination of magnetic resonance imaging and targeted contrast agent for the diagnosis of myocardial infarction. Exp Ther Med 2018; 16:3303-3308. [PMID: 30233676 PMCID: PMC6143907 DOI: 10.3892/etm.2018.6600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/05/2018] [Indexed: 12/05/2022] Open
Abstract
Myocardial infarction is one of the most common human cerebrovascular conditions and frequently leads to ischemic stroke. Evidence has indicated that magnetic resonance imaging (MRI) is a potential method for the diagnosis of patients with cardiovascular injury. However, the efficacy of MRI in diagnosing patients with myocardial infarction requires to be improved. In the present study, a novel nano-size contrast agent, a chitosan/Fe3O4-enclosed albumin (CFEA), was introduced that was used to quantify blood volume and permeability in the infarcted myocardium. A total of 68 patients with suspected myocardial infarction were recruited to analyze the efficacy of MRI combined with CFEA (MRI-CFEA). All patients received diagnosis by MRI and MRI-CFEA. It was revealed that MRI-CFEA provided a higher signal intensity than MRI in the same patients. It was demonstrated that the diagnostic efficacy of MRI-CFEA for patients with myocardial infarction was higher than that of MRI (P<0.05). By MRI-CFEA, 50/68 of cases with myocardial infarction were diagnosed, providing a significantly higher diagnostic rate compared with the 38/68 of cases diagnosed by contrast-enhanced MRI (P<0.01). MRI-CFEA successfully discriminated the infarcted regions based on a decreased fractional blood volume and increased permeability-surface (PS) area product in the infarcted myocardium. A pharmacodynamics analysis indicated that CFEA was eliminated within 24 h in all individuals. In conclusion, the present study provided a novel method to diagnose infarcted myocardium for patients with myocardial infarction, providing an imaging biomarker for the assessment of endothelial dysfunction in the clinic.
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Affiliation(s)
- Jiangjun Qin
- Department of Radiology, The Third People's Hospital of Hainan, Sanya, Hainan 571100, P.R. China
| | - Shuchang Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhiwei Li
- Department of Radiology, The Third People's Hospital of Hainan, Sanya, Hainan 571100, P.R. China
| | - Yinan Chen
- Department of Ultrasound, Sanya Maternity and Child Health Care Hospital, Sanya, Hainan 572000, P.R. China
| | - Qun Qin
- Department of Radiology, The Third People's Hospital of Hainan, Sanya, Hainan 571100, P.R. China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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24
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Nazir MS, Ismail TF, Reyes E, Chiribiri A, Kaufmann PA, Plein S. Hybrid positron emission tomography-magnetic resonance of the heart: current state of the art and future applications. Eur Heart J Cardiovasc Imaging 2018; 19:962-974. [PMID: 30010838 PMCID: PMC6102801 DOI: 10.1093/ehjci/jey090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/11/2018] [Accepted: 06/12/2018] [Indexed: 02/07/2023] Open
Abstract
Hybrid positron emission tomography-magnetic resonance (PET-MR) imaging is a novel imaging modality with emerging applications for cardiovascular disease. PET-MR aims to combine the high-spatial resolution morphological and functional assessment afforded by magnetic resonance imaging (MRI) with the ability of positron emission tomography (PET) for quantification of metabolism, perfusion, and inflammation. The fusion of these two modalities into a single imaging platform not only represents an opportunity to acquire complementary information from a single scan, but also allows motion correction for PET with reduction in ionising radiation. This article presents a brief overview of PET-MR technology followed by a review of the published literature on the clinical cardio-vascular applications of PET and MRI performed separately and with hybrid PET-MR.
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Affiliation(s)
- Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Eliana Reyes
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Sven Plein
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, UK
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25
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Abstract
Imaging in heart failure (HF) provides data for diagnosis, prognosis and disease monitoring. Both MRI and nuclear imaging techniques have been successfully used for this purpose in HF. Positron Emission Tomography-Cardiac Magnetic Resonance (PET-CMR) is an example of a new multimodality diagnostic imaging technique with potential applications in HF. The threshold for adopting a new diagnostic tool to clinical practice must necessarily be high, lest they exacerbate costs without improving care. New modalities must demonstrate clinical superiority, or at least equivalence, combined with another important advantage, such as lower cost or improved patient safety. The purpose of this review is to outline the current status of multimodality PET-CMR with regard to HF applications, and determine whether the clinical utility of this new technology justifies the cost.
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Affiliation(s)
- Michael A Quail
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520-8017, USA.,Institute of Cardiovascular Science, University College London, London, UK
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520-8017, USA. .,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
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26
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Nielsen R, Jorsal A, Iversen P, Tolbod L, Bouchelouche K, Sørensen J, Harms HJ, Flyvbjerg A, Bøtker HE, Wiggers H. Heart failure patients with prediabetes and newly diagnosed diabetes display abnormalities in myocardial metabolism. J Nucl Cardiol 2018; 25:169-176. [PMID: 27473218 DOI: 10.1007/s12350-016-0622-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/07/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND In type 2 diabetes, a decrease in myocardial glucose uptake (MGU) may lower glucose oxidation and contribute to progression of chronic heart failure (CHF). However, it is unsettled whether CHF patients with prediabetes have abnormal MGU and myocardial blood flow (MBF) during normal physiological conditions. METHODS AND RESULTS We studied 35 patients with CHF and reduced left ventricular ejections fraction (34 ± 9%) without overt T2D (mean HbA1c: 40 ± 4 mmol/mol) using echocardiography and quantitative measurements of MGU by 18F-FDG-PET and perfusion by 15O-H2O-PET. An oral glucose tolerance test (OGTT) was performed during the FDG-PET, which identified 17 patients with abnormal and 18 patients with normal glucometabolic response. Global MGU was higher in patients with normal OGTT response (0.31 ± 0.09 µmol/g/min) compared with patients with abnormal OGTT response (0.25 ± 0.09 µmol/g/min) (P = 0.05). MBF (P = 0.22) and myocardial flow reserve (MFR) (P = 0.83) were similar in the study groups. The reduced MGU in prediabetic patients was attributable to reduced MGU in viable myocardium with normal MFR (P < 0.001). CONCLUSION CHF patients with prediabetes have reduced MGU in segments with preserved MFR as compared to CHF patients with normal glucose tolerance. Whether reversal of these myocardial abnormalities can improve outcome needs to be investigated in large-scale studies.
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Affiliation(s)
- Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Anders Jorsal
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter Iversen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sørensen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Allan Flyvbjerg
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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27
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Cabello J, Ziegler SI. Advances in PET/MR instrumentation and image reconstruction. Br J Radiol 2018; 91:20160363. [PMID: 27376170 PMCID: PMC5966194 DOI: 10.1259/bjr.20160363] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 12/15/2022] Open
Abstract
The combination of positron emission tomography (PET) and MRI has attracted the attention of researchers in the past approximately 20 years in small-animal imaging and more recently in clinical research. The combination of PET/MRI allows researchers to explore clinical and research questions in a wide number of fields, some of which are briefly mentioned here. An important number of groups have developed different concepts to tackle the problems that PET instrumentation poses to the exposition of electromagnetic fields. We have described most of these research developments in preclinical and clinical experiments, including the few commercial scanners available. From the software perspective, an important number of algorithms have been developed to address the attenuation correction issue and to exploit the possibility that MRI provides for motion correction and quantitative image reconstruction, especially parametric modelling of radiopharmaceutical kinetics. In this work, we give an overview of some exemplar applications of simultaneous PET/MRI, together with technological hardware and software developments.
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Affiliation(s)
- Jorge Cabello
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sibylle I Ziegler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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28
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O'Doherty J, Sammut E, Schleyer P, Stirling J, Nazir MS, Marsden PK, Chiribiri A. Feasibility of simultaneous PET-MR perfusion using a novel cardiac perfusion phantom. Eur J Hybrid Imaging 2017; 1:4. [PMID: 29782598 PMCID: PMC5954708 DOI: 10.1186/s41824-017-0008-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/01/2017] [Indexed: 01/29/2023] Open
Abstract
Background PET-MR scanners are beginning to be employed for quantitative myocardial perfusion imaging. In order to examine simultaneous perfusion calculations, this work describes a feasibility study of simultaneous PET-MR of gadolinium-based contrast agent (GBCA) and PET radiotracer in a novel cardiac perfusion phantom. Results [18F]F− and GBCA were injected simultaneously into a cardiac phantom using a range of ground-truth myocardial perfusion rates of 1 to 5 ml/g/min. PET quantification of K1 (ml/g/min) was performed using a single tissue compartment model. MR perfusion was calculated using a model-independent signal deconvolution technique. PET and MR signal traces from the phantom aorta and myocardial sections show true simultaneous PET and MR arterial input functions (AIF) and myocardial uptake respectively at each perfusion rate. Calculation of perfusion parameters showed both K1 and h(t = 0) (PET and MR perfusion parameters respectively) to be linearly related with the ground truth perfusion rate (PT), and also linearly related to each other (R2 = 0.99). The highest difference in perfusion values between K1 and PT was 16% at 1 ml/g/min, and the mean difference for all other perfusion rates was <3%. Conclusions The perfusion phantom allows accurate and reproducible simulation of the myocardial kinetics for simultaneous PET-MR imaging, and may find use in protocol design and development of PET-MR based quantification techniques and direct comparison of quantification of the two modalities.
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Affiliation(s)
- Jim O'Doherty
- 1Division of Imaging Sciences and Biomedical Engineering, PET Imaging Centre, King's College London, St. Thomas' Hospital, 1st Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH UK
| | - Eva Sammut
- 2Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St. Thomas' Hospital, London, UK.,3Bristol Heart Institute, Bristol, UK
| | | | - James Stirling
- 1Division of Imaging Sciences and Biomedical Engineering, PET Imaging Centre, King's College London, St. Thomas' Hospital, 1st Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH UK
| | - Muhummad Sohaib Nazir
- 2Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St. Thomas' Hospital, London, UK.,5Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul K Marsden
- 1Division of Imaging Sciences and Biomedical Engineering, PET Imaging Centre, King's College London, St. Thomas' Hospital, 1st Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH UK
| | - Amedeo Chiribiri
- 2Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St. Thomas' Hospital, London, UK.,5Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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29
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Robson PM, Dey D, Newby DE, Berman D, Li D, Fayad ZA, Dweck MR. MR/PET Imaging of the Cardiovascular System. JACC Cardiovasc Imaging 2017; 10:1165-1179. [PMID: 28982570 PMCID: PMC6415529 DOI: 10.1016/j.jcmg.2017.07.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
Abstract
Cardiovascular imaging has largely focused on identifying structural, functional, and metabolic changes in the heart. The ability to reliably assess disease activity would have major potential clinical advantages, including the identification of early disease, differentiating active from stable conditions, and monitoring disease progression or response to therapy. Positron emission tomography (PET) imaging now allows such assessments of disease activity to be acquired in the heart, whereas magnetic resonance (MR) scanning provides detailed anatomic imaging and tissue characterization. Hybrid MR/PET scanners therefore combine the strengths of 2 already powerful imaging modalities. Simultaneous acquisition of the 2 scans also provides added benefits, including improved scanning efficiency, motion correction, and partial volume correction. Radiation exposure is lower than with hybrid PET/computed tomography scanning, which might be particularly beneficial in younger patients who may need repeated scans. The present review discusses the expanding clinical literature investigating MR/PET imaging, highlights its advantages and limitations, and explores future potential applications.
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Affiliation(s)
- Philip M Robson
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Daniel Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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30
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Nekolla SG, van Marwick S, Schachoff S, Kunze KP, Rischpler C. Cardiovascular PET/MRI: Technical Considerations and Outlook. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Munoz C, Neji R, Cruz G, Mallia A, Jeljeli S, Reader AJ, Botnar RM, Prieto C. Motion-corrected simultaneous cardiac positron emission tomography and coronary MR angiography with high acquisition efficiency. Magn Reson Med 2017; 79:339-350. [PMID: 28426162 PMCID: PMC5763353 DOI: 10.1002/mrm.26690] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 12/12/2022]
Abstract
Purpose Develop a framework for efficient free‐breathing simultaneous whole‐heart coronary magnetic resonance angiography (CMRA) and cardiac positron emission tomography (PET) on a 3 Tesla PET‐MR system. Methods An acquisition that enables nonrigid motion correction of both CMRA and PET has been developed. The proposed method estimates translational motion from low‐resolution 2D MR image navigators acquired at each heartbeat and 3D nonrigid respiratory motion between different respiratory bins from the CMRA data itself. Estimated motion is used for correcting the CMRA as well as the emission and attenuation PET data sets to the same respiratory position. The CMRA approach was studied in 10 healthy subjects and compared for both left and right coronary arteries (LCA, RCA) against a reference scan with diaphragmatic navigator gating and tracking. The PET‐CMRA approach was tested in 5 oncology patients with 18F‐FDG myocardial uptake. PET images were compared against uncorrected and gated PET reconstructions. Results For the healthy subjects, no statistically significant differences in vessel length and sharpness (P > 0.01) were observed between the proposed approach and the reference acquisition with navigator gating and tracking, although data acquisition was significantly shorter. The proposed approach improved CMRA vessel sharpness by 37.9% and 49.1% (LCA, RCA) and vessel length by 48.0% and 36.7% (LCA, RCA) in comparison with no motion correction for all the subjects. Motion‐corrected PET images showed improved sharpness of the myocardium compared to uncorrected reconstructions and reduced noise compared to gated reconstructions. Conclusion Feasibility of a new respiratory motion‐compensated simultaneous cardiac PET‐CMRA acquisition has been demonstrated. Magn Reson Med 79:339–350, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Camila Munoz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare, Frimley, United Kingdom
| | - Gastão Cruz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Andrew Mallia
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,PET Centre, St Thomas' Hospital, King's College London & Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sami Jeljeli
- PET Centre, St Thomas' Hospital, King's College London & Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew J Reader
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Rene M Botnar
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Escuela de Ingenieria, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Claudia Prieto
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.,Escuela de Ingenieria, Pontificia Universidad Catolica de Chile, Santiago, Chile
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32
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Abstract
Cardiovascular diseases are a consequence of genetic and environmental risk factors that together generate arterial wall and cardiac pathologies. Blood vessels connect multiple systems throughout the entire body and allow organs to interact via circulating messengers. These same interactions facilitate nervous and metabolic system's influence on cardiovascular health. Multiparametric imaging offers the opportunity to study these interfacing systems' distinct processes, to quantify their interactions, and to explore how these contribute to cardiovascular disease. Noninvasive multiparametric imaging techniques are emerging tools that can further our understanding of this complex and dynamic interplay. Positron emission tomography/magnetic resonance imaging and multichannel optical imaging are particularly promising because they can simultaneously sample multiple biomarkers. Preclinical multiparametric diagnostics could help discover clinically relevant biomarker combinations pivotal for understanding cardiovascular disease. Interfacing systems important to cardiovascular disease include the immune, nervous, and hematopoietic systems. These systems connect with classical cardiovascular organs, such as the heart and vasculature, and with the brain. The dynamic interplay between these systems and organs enables processes, such as hemostasis, inflammation, angiogenesis, matrix remodeling, metabolism, and fibrosis. As the opportunities provided by imaging expand, mapping interconnected systems will help us decipher the complexity of cardiovascular disease and monitor novel therapeutic strategies.
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Affiliation(s)
- Katrien Vandoorne
- From the Center for Systems Biology (K.V., M.N.) and Department of Imaging (K.V., M.N.), Massachusetts General Hospital and Harvard Medical School, Boston; and Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (M.N.)
| | - Matthias Nahrendorf
- From the Center for Systems Biology (K.V., M.N.) and Department of Imaging (K.V., M.N.), Massachusetts General Hospital and Harvard Medical School, Boston; and Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (M.N.).
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33
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MacAskill MG, Tavares AS, Wu J, Lucatelli C, Mountford JC, Baker AH, Newby DE, Hadoke PWF. PET Cell Tracking Using 18F-FLT is Not Limited by Local Reuptake of Free Radiotracer. Sci Rep 2017; 7:44233. [PMID: 28287126 PMCID: PMC5347009 DOI: 10.1038/srep44233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/06/2017] [Indexed: 12/27/2022] Open
Abstract
Assessing the retention of cell therapies following implantation is vital and often achieved by labelling cells with 2'-[18F]-fluoro-2'-deoxy-D-glucose (18F-FDG). However, this approach is limited by local retention of cell-effluxed radiotracer. Here, in a preclinical model of critical limb ischemia, we assessed a novel method of cell tracking using 3'-deoxy-3'-L-[18F]-fluorothymidine (18F-FLT); a clinically available radiotracer which we hypothesise will result in minimal local radiotracer reuptake and allow a more accurate estimation of cell retention. Human endothelial cells (HUVECs) were incubated with 18F-FDG or 18F-FLT and cell characteristics were evaluated. Dynamic positron emission tomography (PET) images were acquired post-injection of free 18F-FDG/18F-FLT or 18F-FDG/18F-FLT-labelled HUVECs, following the surgical induction of mouse hind-limb ischemia. In vitro, radiotracer incorporation and efflux was similar with no effect on cell viability, function or proliferation under optimised conditions (5 MBq/mL, 60 min). Injection of free radiotracer demonstrated a faster clearance of 18F-FLT from the injection site vs. 18F-FDG (p ≤ 0.001), indicating local cellular uptake. Using 18F-FLT-labelling, estimation of HUVEC retention within the engraftment site 4 hr post-administration was 24.5 ± 3.2%. PET cell tracking using 18F-FLT labelling is an improved approach vs. 18F-FDG as it is not susceptible to local host cell reuptake, resulting in a more accurate estimation of cell retention.
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Affiliation(s)
- Mark G MacAskill
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Adriana S Tavares
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Junxi Wu
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Joanne C Mountford
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Andrew H Baker
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Patrick W F Hadoke
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Keliher EJ, Ye YX, Wojtkiewicz GR, Aguirre AD, Tricot B, Senders ML, Groenen H, Fay F, Perez-Medina C, Calcagno C, Carlucci G, Reiner T, Sun Y, Courties G, Iwamoto Y, Kim HY, Wang C, Chen JW, Swirski FK, Wey HY, Hooker J, Fayad ZA, Mulder WJM, Weissleder R, Nahrendorf M. Polyglucose nanoparticles with renal elimination and macrophage avidity facilitate PET imaging in ischaemic heart disease. Nat Commun 2017; 8:14064. [PMID: 28091604 PMCID: PMC5241815 DOI: 10.1038/ncomms14064] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/24/2016] [Indexed: 01/21/2023] Open
Abstract
Tissue macrophage numbers vary during health versus disease. Abundant inflammatory macrophages destruct tissues, leading to atherosclerosis, myocardial infarction and heart failure. Emerging therapeutic options create interest in monitoring macrophages in patients. Here we describe positron emission tomography (PET) imaging with 18F-Macroflor, a modified polyglucose nanoparticle with high avidity for macrophages. Due to its small size, Macroflor is excreted renally, a prerequisite for imaging with the isotope flourine-18. The particle's short blood half-life, measured in three species, including a primate, enables macrophage imaging in inflamed cardiovascular tissues. Macroflor enriches in cardiac and plaque macrophages, thereby increasing PET signal in murine infarcts and both mouse and rabbit atherosclerotic plaques. In PET/magnetic resonance imaging (MRI) experiments, Macroflor PET imaging detects changes in macrophage population size while molecular MRI reports on increasing or resolving inflammation. These data suggest that Macroflor PET/MRI could be a clinical tool to non-invasively monitor macrophage biology. In vivo imaging of inflammation is crucial for detection and monitoring of many pathologies and noninvasive macrophage quantification has been suggested as a possible approach. Here Keliher et al. describe novel polyglucose nanoparticle tracers that are rapidly excreted by the kidney and with high affinity for macrophages in atherosclerotic plaques.
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Affiliation(s)
- Edmund J Keliher
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Yu-Xiang Ye
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Gregory R Wojtkiewicz
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Aaron D Aguirre
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Benoit Tricot
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Max L Senders
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.,Department of Medical Biochemistry, Subdivision of Experimental Vascular Biology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Hannah Groenen
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA
| | - Francois Fay
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA
| | - Carlos Perez-Medina
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA
| | - Giuseppe Carlucci
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065, USA.,Department of Radiology, Weill Cornell Medical College, New York, New York 10065, USA
| | - Yuan Sun
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Gabriel Courties
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Yoshiko Iwamoto
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Hye-Yeong Kim
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Cuihua Wang
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - John W Chen
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Filip K Swirski
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
| | - Hsiao-Ying Wey
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Imaging, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, Massachusetts 02129, USA
| | - Jacob Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Imaging, Massachusetts General Hospital, Harvard Medical School, 149 Thirteenth Street, Charlestown, Massachusetts 02129, USA
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA
| | - Willem J M Mulder
- Translational and Molecular Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, USA.,Department of Medical Biochemistry, Subdivision of Experimental Vascular Biology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ralph Weissleder
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA.,Department of Systems Biology, Harvard Medical School, 200 Longwood Avenue, Alpert 536, Boston, Massachusetts 02115, USA
| | - Matthias Nahrendorf
- Center for Systems Biology and Department of Imaging, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA.,Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, Massachusetts 02114, USA
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Abstract
In vivo imaging, which enables us to peer deeply within living subjects, is producing tremendous opportunities both for clinical diagnostics and as a research tool. Contrast material is often required to clearly visualize the functional architecture of physiological structures. Recent advances in nanomaterials are becoming pivotal to generate the high-resolution, high-contrast images needed for accurate, precision diagnostics. Nanomaterials are playing major roles in imaging by delivering large imaging payloads, yielding improved sensitivity, multiplexing capacity, and modularity of design. Indeed, for several imaging modalities, nanomaterials are now not simply ancillary contrast entities, but are instead the original and sole source of image signal that make possible the modality's existence. We address the physicochemical makeup/design of nanomaterials through the lens of the physical properties that produce contrast signal for the cognate imaging modality-we stratify nanomaterials on the basis of their (i) magnetic, (ii) optical, (iii) acoustic, and/or (iv) nuclear properties. We evaluate them for their ability to provide relevant information under preclinical and clinical circumstances, their in vivo safety profiles (which are being incorporated into their chemical design), their modularity in being fused to create multimodal nanomaterials (spanning multiple different physical imaging modalities and therapeutic/theranostic capabilities), their key properties, and critically their likelihood to be clinically translated.
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Affiliation(s)
- Bryan Ronain Smith
- Stanford University , 3155 Porter Drive, #1214, Palo Alto, California 94304-5483, United States
| | - Sanjiv Sam Gambhir
- The James H. Clark Center , 318 Campus Drive, First Floor, E-150A, Stanford, California 94305-5427, United States
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Cardiovascular PET/MRI: Initial Clinical Experience. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9392-y] [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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Clinical Utility and Future Applications of PET/CT and PET/CMR in Cardiology. Diagnostics (Basel) 2016; 6:diagnostics6030032. [PMID: 27598207 PMCID: PMC5039566 DOI: 10.3390/diagnostics6030032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/17/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022] Open
Abstract
Over the past several years, there have been major advances in cardiovascular positron emission tomography (PET) in combination with either computed tomography (CT) or, more recently, cardiovascular magnetic resonance (CMR). These multi-modality approaches have significant potential to leverage the strengths of each modality to improve the characterization of a variety of cardiovascular diseases and to predict clinical outcomes. This review will discuss current developments and potential future uses of PET/CT and PET/CMR for cardiovascular applications, which promise to add significant incremental benefits to the data provided by each modality alone.
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Li Y, Li C, Jin H, Huang W. Magnetic resonance imaging in interventional therapy of patients with acute myocardial infarction prior to and after treatment. Exp Ther Med 2016; 12:1755-1759. [PMID: 27588093 PMCID: PMC4998127 DOI: 10.3892/etm.2016.3537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/21/2016] [Indexed: 01/06/2023] Open
Abstract
The aim of the study was to investigate the cardiac magnetic resonance (CMR) imaging in interventional therapy of patients with acute myocardial infarction prior to and after treatment. Fifty-six cases of AMI patients with elective treatment by percutaneous coronary intervention (PCI) were continuously selected. Patients with an incidence of 7–10 days were treated with CMR and echocardiography to evaluate the quality of myocardial infarction, visual score method (VSM), wall motion score abnormality, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF). Patients with an incidence of 10–14 days were treated with PCI, and CMR and echocardiography were evaluated after 6 months, after which the occurrence of major adverse cardiac events (MACE) were compared. The infarction quality, VSM score and wall motion abnormality (WMA) score were significantly reduced following surgery, and the difference was statistically significant (P<0.05). Ultrasound evaluation of LVEDD, LVESD, and LVEF prior to and after surgery was compared, and the difference was not statistically significant (P>0.05). Evaluation of the magnetic resonance imaging (MRI) in LVEDD prior to surgery was increased compared with that of the ultrasound in LVEDD, whereas MRI in LVESD and LVEF was decreased compared to that of the ultrasound obtained for LVESD and LVEF. Additionally, postoperative LVEDD was reduced compared with preoperative LVEDD, whereas LVEF was increased, and the difference was statistically significant (P<0.05). However, the evaluation of LVESD using the two methods exhibited no significant change. MACE occurred in 7 (12.5%) of 56 cases. The infarction quality of patients in the MACE group following surgery indicated that VSM and WMA scores were significantly higher than the group without MACE, while LVEF was lower than the MACE group following surgery, and the difference was statistically significant (P<0.05), albeit the ultrasound results of LVEF indicated no difference. In conclusion, CMR evaluation of AMI patients with elective PCI treatment in myocardial remodeling and cardiac function were more sensitive and accurate than with cardiac ultrasound.
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Affiliation(s)
- Yuzhou Li
- Medical Image Center, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
| | - Chunrong Li
- Medical Image Center, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
| | - Hongrui Jin
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Wenqi Huang
- Medical Image Center, The First People's Hospital of Shangqiu, Shangqiu, Henan 476100, P.R. China
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Bulluck H, White SK, Fröhlich GM, Casson SG, O'Meara C, Newton A, Nicholas J, Weale P, Wan SMY, Sirker A, Moon JC, Yellon DM, Groves A, Menezes L, Hausenloy DJ. Quantifying the Area at Risk in Reperfused ST-Segment-Elevation Myocardial Infarction Patients Using Hybrid Cardiac Positron Emission Tomography-Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2016; 9:e003900. [PMID: 26926269 DOI: 10.1161/circimaging.115.003900] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hybrid positron emission tomography and magnetic resonance allows the advantages of magnetic resonance in tissue characterizing the myocardium to be combined with the unique metabolic insights of positron emission tomography. We hypothesized that the area of reduced myocardial glucose uptake would closely match the area at risk delineated by T2 mapping in ST-segment-elevation myocardial infarction patients. METHODS AND RESULTS Hybrid positron emission tomography and magnetic resonance using (18)F-fluorodeoxyglucose (FDG) for glucose uptake was performed in 21 ST-segment-elevation myocardial infarction patients at a median of 5 days. Follow-up scans were performed in a subset of patients 12 months later. The area of reduced FDG uptake was significantly larger than the infarct size quantified by late gadolinium enhancement (37.2±11.6% versus 22.3±11.7%; P<0.001) and closely matched the area at risk by T2 mapping (37.2±11.6% versus 36.3±12.2%; P=0.10, R=0.98, bias 0.9±4.4%). On the follow-up scans, the area of reduced FDG uptake was significantly smaller in size when compared with the acute scans (19.5 [6.3%-31.8%] versus 44.0 [21.3%-55.3%]; P=0.002) and closely correlated with the areas of late gadolinium enhancement (R 0.98) with a small bias of 2.0±5.6%. An FDG uptake of ≥45% on the acute scans could predict viable myocardium on the follow-up scan. Both transmural extent of late gadolinium enhancement and FDG uptake on the acute scan performed equally well to predict segmental wall motion recovery. CONCLUSIONS Hybrid positron emission tomography and magnetic resonance in the reperfused ST-segment-elevation myocardial infarction patients showed reduced myocardial glucose uptake within the area at risk and closely matched the area at risk delineated by T2 mapping. FDG uptake, as well as transmural extent of late gadolinium enhancement, acutely can identify viable myocardial segments.
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Affiliation(s)
- Heerajnarain Bulluck
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Steven K White
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
| | - Georg M Fröhlich
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Steven G Casson
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Celia O'Meara
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Ayla Newton
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Jennifer Nicholas
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Peter Weale
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Simon M Y Wan
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Alex Sirker
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - James C Moon
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Derek M Yellon
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Ashley Groves
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Leon Menezes
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
| | - Derek J Hausenloy
- From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.)
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40
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Recent Developments in Combined PET/MRI. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0149-9] [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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Nekolla SG, Martinez-Möller A. Attenuation correction in cardiac PET: To raise awareness for a problem which is as old as PET/CT. J Nucl Cardiol 2015; 22:1296-9. [PMID: 25762033 DOI: 10.1007/s12350-015-0083-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Stephan G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- DZKH (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), partner site Munich Heart Alliance, Munich, Germany.
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Greulich S, Sechtem U. Multimodality imaging in coronary artery disease - "The more the better?". COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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