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Knuuti J, Tuisku J, Kärpijoki H, Iida H, Maaniitty T, Latva-Rasku A, Oikonen V, Nesterov SV, Teuho J, Jaakkola MK, Klén R, Louhi H, Saunavaara V, Nuutila P, Saraste A, Rinne J, Nummenmaa L. Quantitative Perfusion Imaging with Total-Body PET. J Nucl Med 2023; 64:11S-19S. [PMID: 37918848 DOI: 10.2967/jnumed.122.264870] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/04/2023] [Indexed: 11/04/2023] Open
Abstract
Recently, PET systems with a long axial field of view have become the current state of the art. Total-body PET scanners enable unique possibilities for scientific research and clinical diagnostics, but this new technology also raises numerous challenges. A key advantage of total-body imaging is that having all the organs in the field of view allows studying biologic interaction of all organs simultaneously. One of the new, promising imaging techniques is total-body quantitative perfusion imaging. Currently, 15O-labeled water provides a feasible option for quantitation of tissue perfusion at the total-body level. This review summarizes the status of the methodology and the analysis and provides examples of preliminary findings on applications of quantitative parametric perfusion images for research and clinical work. We also describe the opportunities and challenges arising from moving from single-organ studies to modeling of a multisystem approach with total-body PET, and we discuss future directions for total-body imaging.
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Affiliation(s)
- Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland;
- Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital, Turku, Finland; and
| | - Jouni Tuisku
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Henri Kärpijoki
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Hidehiro Iida
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine, and PET, Turku University Hospital, Turku, Finland; and
| | - Aino Latva-Rasku
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Vesa Oikonen
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Sergey V Nesterov
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria K Jaakkola
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Riku Klén
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Heli Louhi
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Pirjo Nuutila
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Rinne
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Lauri Nummenmaa
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
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Improving Detection of CAD and Prognosis with PET/CT Quantitative Absolute Myocardial Blood Flow Measurements. Curr Cardiol Rep 2022; 24:1855-1864. [PMID: 36348147 DOI: 10.1007/s11886-022-01805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the role of PET MPI in the detection of CAD, focussing on the added value of MBF for diagnosis and prognostication. RECENT FINDINGS Positron emission tomography (PET) myocardial perfusion imaging (MPI) is increasingly used for the risk stratification of patients with suspected or established coronary artery disease (CAD). PET MPI provides accurate and reproducible non-invasive quantification of myocardial blood flow (MBF) at rest and during hyperemia, providing incremental information over conventional myocardial perfusion alone. Inclusion of MBF in PET MPI interpretation improves both its sensitivity and specificity. Moreover, quantitative MBF measurements have repeatedly been shown to offer incremental and independent prognostic information over conventional clinical markers in a broad range of conditions, including in CAD. Quantitative MBF measurement is now an established and powerful tool enabling accurate risk stratification and guiding patients' management. The role of PET MPI and flow quantification in cardiac allograft vasculopathy (CAV), which represents a particular form of CAD, will also be reviewed.
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Baggiano A, Italiano G, Guglielmo M, Fusini L, Guaricci AI, Maragna R, Giacari CM, Mushtaq S, Conte E, Annoni AD, Formenti A, Mancini ME, Andreini D, Rabbat M, Pepi M, Pontone G. Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging. J Clin Med 2022; 11:jcm11030477. [PMID: 35159929 PMCID: PMC8836710 DOI: 10.3390/jcm11030477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/24/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.
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Affiliation(s)
- Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gianpiero Italiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, 70124 Bari, Italy;
| | - Riccardo Maragna
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Carlo Maria Giacari
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Saima Mushtaq
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Edoardo Conte
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Andrea Daniele Annoni
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Alberto Formenti
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Maria Elisabetta Mancini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Daniele Andreini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mark Rabbat
- Division of Cardiology, Department of Medicine and Radiology, Loyola University of Chicago, Chicago, IL 60660, USA;
- Division of Cardiology, Department of Medicine, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Mauro Pepi
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Correspondence: ; Tel.: +39-02-5800-2574; Fax: +39-02-5800-2231
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