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Besson FL, Treglia G, Bucerius J, Anagnostopoulos C, Buechel RR, Dweck MR, Erba PA, Gaemperli O, Gimelli A, Gheysens O, Glaudemans AWJM, Habib G, Hyafil F, Lubberink M, Rischpler C, Saraste A, Slart RHJA. A systematic review for the evidence of recommendations and guidelines in hybrid nuclear cardiovascular imaging. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06597-x. [PMID: 38221570 DOI: 10.1007/s00259-024-06597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVES This study aimed to evaluate the level of evidence of expert recommendations and guidelines for clinical indications and procedurals in hybrid nuclear cardiovascular imaging. METHODS From inception to August 2023, a PubMed literature analysis of the latest version of guidelines for clinical hybrid cardiovascular imaging techniques including SPECT(/CT), PET(/CT), and PET(/MRI) was performed in two categories: (1) for clinical indications for all-in primary diagnosis; subgroup in prognosis and therapy evaluation; and for (2) imaging procedurals. We surveyed to what degree these followed a standard methodology to collect the data and provide levels of evidence, and for which topic systematic review evidence was executed. RESULTS A total of 76 guidelines, published between 2013 and 2023, were included. The evidence of guidelines was based on systematic reviews in 7.9% of cases, non-systematic reviews in 47.4% of cases, a mix of systematic and non-systematic reviews in 19.7%, and 25% of guidelines did not report any evidence. Search strategy was reported in 36.8% of cases. Strengths of recommendation were clearly reported in 25% of guidelines. The notion of external review was explicitly reported in 23.7% of cases. Finally, the support of a methodologist was reported in 11.8% of the included guidelines. CONCLUSION The use of evidence procedures for developing for evidence-based cardiovascular hybrid imaging recommendations and guidelines is currently suboptimal, highlighting the need for more standardized methodological procedures.
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Affiliation(s)
- Florent L Besson
- Department of Nuclear Medicine-Molecular Imaging, DMU SMART IMAGING, Hôpitaux Universitaires Paris-Saclay, AP-HP, CHU Bicêtre, Le Kremlin Bicetre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicetre, France
- Commissariat À L'énergie Atomique Et Aux Énergies Alternatives (CEA), Centre National de La Recherche Scientifique (CNRS), Inserm, BioMaps, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Universitätsmedizin Göttingen, Gottingen, Germany
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Paula A Erba
- Department of Medicine and Surgery, University of Milan Bicocca, and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
| | - Fabian Hyafil
- Department of Nuclear Medicine, DMU IMAGINA, Georges-Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, F75015, Paris, France
| | - Mark Lubberink
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
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Kupusovic J, Weber M, Bruns F, Kessler L, Pesch E, Bohnen J, Dobrev D, Rassaf T, Wakili R, Rischpler C, Siebermair J. PET/CT-identified atrial hypermetabolism is an index of atrial inflammation in patients with atrial fibrillation. J Nucl Cardiol 2023; 30:1761-1772. [PMID: 37592057 DOI: 10.1007/s12350-023-03248-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/17/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Although atrial inflammation has been implicated in the pathophysiology of atrial fibrillation (AF), the identification of atrial inflammation remains challenging. We aimed to establish a positron emission tomography/computed tomography (PET/CT) protocol with 18Fluor-labeled fluorodeoxyglucose (18F-FDG) for the detection of atrial hypermetabolism as surrogate for inflammation in AF. METHODS We included n = 75 AF and n = 75 non-AF patients undergoing three common PET/CT protocols (n = 25 per group) optimized for the detection of (a) inflammation and (b) malignancy in predefined fasting protocols, and (c) cardiac viability allowing for maximized glucose uptake. 18F-FDG-uptake was analyzed in predefined loci. RESULTS Differences of visual atrial uptake in AF vs non-AF patients were observed in fasting (inflammation [13/25 vs 0/25] and malignancy [10/25 vs 0/25]) protocols while viability protocols showed non-specific uptake in both the groups. In the inflammation protocol, AF patients showed higher uptake in the right atrium [(SUVmax: 2.5 ± .7 vs 2.0 ± .7, P = .01), atrial appendage (SUVmax: 2.4 ± .7 vs 2.0 ± .6, P = .03), and epicardial adipose tissue (SUVmax: 1.4 ± .5 vs 1.1 ± .4, P = .04)]. Malignancy and viability protocols failed to differentiate between AF and non-AF. CONCLUSION Glucose uptake suppression protocols appear suitable in detecting differential atrial 18F-FDG uptake between AF and non-AF patients. Imaging-based assessment of inflammation might help to stratify AF patients offering individualized therapeutic approaches.
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Affiliation(s)
- J Kupusovic
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Department of Cardiology and Vascular Medicine, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - M Weber
- Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany
| | - F Bruns
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - L Kessler
- Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany
| | - E Pesch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - J Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - D Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada
| | - T Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - R Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
- Department of Cardiology and Vascular Medicine, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
- German Centre for Cardiovascular Research (DZHK) Partner Site Rhine/Main, Frankfurt, Germany.
| | - C Rischpler
- Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany
- Department of Nuclear Medicine, Klinikum Stuttgart, Stuttgart, Germany
| | - J Siebermair
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Department of Cardiology, Krankenhaus Göttlicher Heiland GmbH, Vienna, Austria
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Lindner O, Schäfer W, Rischpler C, Silber S, Burchert W. Myocardial perfusion SPECT in Germany from 2012 to 2021: insights into development and quality indicators. Eur J Nucl Med Mol Imaging 2023; 50:1621-1628. [PMID: 36780003 PMCID: PMC9923638 DOI: 10.1007/s00259-023-06129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/26/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE This paper summarises the results of 4 national surveys on the numbers, utilisation and technique of myocardial perfusion SPECT (MPS) from 2012 to 2021. METHODS A one-page questionnaire for information on MPS in 2012, 2015, 2018 and 2021 was sent to German centres practising nuclear medicine. To check for representativeness, the numbers obtained were related to official annual data and furthermore to the numbers of invasive coronary angiography procedures (ICA). RESULTS MPS examinations increased by > 40% from 2012 to 2021 and showed a centralisation with increasing MPS per centre. In 2020, a mild impact of the COVID-19 pandemic could be observed in the form of only a slight MPS increase, which was compensated in the following year. Outpatient care cardiologists represent the most important referrer (70%). Mostly, 2-day protocols were used. One-day protocols and stress-only protocols showed insignificant changes. The use of exercise stress decreased steadily. In 2021, exercise stress was replaced by pharmacological stress as the most frequent stress modality. Camera systems showed a shift to more SPECT-CT systems. The use of gated SPECT increased to almost 90%. Quantitative scoring showed an increasing acceptance. The ratio of invasive coronary angiographies (ICA) to MPS was between 3.9 and 4.5. A significant proportion of ICA in the context of CCS (chronic coronary syndrome) was performed without prior testing for ischaemia. CONCLUSION The 2012 to 2021 MPS surveys reveal a continuously growing number of examinations with only a mild temporary effect of the COVID-19 pandemic and a centralisation with increasing numbers per centre. Performance and technical data reveal a high-grade adherence of MPS practice to the current ESC guideline. A large potential of non-invasive diagnostics remains for the future.
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Affiliation(s)
- O Lindner
- Institut Für Radiologie, Nuklearmedizin Und Molekulare Bildgebung, Herz- Und Diabeteszentrum NRW, Bad Oeynhausen, Germany.
| | - W Schäfer
- Klinik Für Nuklearmedizin, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - C Rischpler
- Klinik Für Nuklearmedizin, Universitätsklinik Essen, Stuttgart, Germany
- Abteilung für Nuklearmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - S Silber
- Kardiologie Zentrum München, Munich, Germany
| | - W Burchert
- Institut Für Radiologie, Nuklearmedizin Und Molekulare Bildgebung, Herz- Und Diabeteszentrum NRW, Bad Oeynhausen, Germany
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Bruckmann MN, Rischpler C, Kirchner J, Baraliakos X. Auswirkungen einer Anti-TNF-Therapie auf die osteoblastische Aktivität bei ankylosierender Spondylitis – Eine prospektive Analyse von PET/MRT-Untersuchungen der Iliosakralgelenke und der Wirbelsäule. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M N Bruckmann
- Universitätsklinikum Düsseldorf, Radiologie, Düsseldorf
| | - C Rischpler
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Duisburg-Essen, Essen
| | - J Kirchner
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet, St.Elisabeth Gruppe, Herne
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Kupusovic J, Weber M, Kessler L, Pesch E, Riesinger L, Wakili R, Dobrev D, Rischpler C, Rassaf T, Siebermair J. Increased FDG uptake in AF individuals suggesting atrial inflammation visualized by FDG PET/CT with glucose uptake suppression protocols. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pathophysiology of atrial fibrillation (AF) is multifactorial. Attention has been drawn towards atrial inflammation underlying arrhythmogenic remodeling. The aim of our study was to evaluate if a specific preparation protocol for positron emission tomography/computed tomography (PET/CT) with 18Fluor-labelled fluorodeoxyglucose (18F-FDG) was capable of detecting atrial hypermetabolism as surrogate for inflammation in AF, with the specific hypothesis that protocols specifically aiming to suppress physiologic glucose metabolism (fasting protocols: inflammation and malignancy preparation) were superior to non-fasting protocols.
Methods
We conducted a single-center study including n=75 patients with a history of AF and n=75 controls without AF (matched for age, sex and left ventricular systolic function) undergoing three different preparation protocols (each n=25 per group): i.) inflammation, ii.) malignancy and iii.) viability protocol before 18F-FDG-PET/CT. We performed visual analysis of local detectable atrial uptake (figure 1A) and assessed quantitative uptake in predetermined loci of the atria and endocrine adipose tissue (EAT), using maximum standardized uptake values (SUVmax) and target to background ratios (TBR).
Results
Our analysis of visual atrial 18F-FDG uptake revealed that atrial uptake was exclusively observed in AF patients using the malignancy (13/25 patients) and inflammation (10/25 patients) protocol, while the viability preparation revealed atrial uptake both in AF (n=6 patients) and non-AF patients (n=5 patients).
With respect to quantitative measures between AF and non-AF individuals using the inflammation protocol, patients with AF showed significantly higher uptake values in the right atrium (SUVmax: 2.54±0.75 vs. 2.03±0.66, p=0.01); TBR 1.51±0.44 vs. 1.18±0.20, p<0.01), right atrial appendage (SUVmax: 2.44±0.71 vs. 2.02±0.64, p=0.03; TBR: 1.47±0.47 vs. 1.20±0.26, p=0.02) and also in EAT (SUVmax: 1.39±0.46 vs. 1.13±0.40, p=0.04), figure 1B. Despite a trend of higher tracer uptake related to the presence of AF in left atrial structures, no statistical significances could be observed between AF and non-AF individuals.
Conclusion
This retrospective study demonstrates that protocols specifically designed to suppress physiologic glucose uptake seem to be superior in detecting atrial FDG uptake, which could be indicative of atrial inflammation in AF patients. Based on our results the right atrium seems to be more affected from these changes. These results point towards a potential role of right atrial inflammatory processes in AF pathophysiology besides the established left atrial ectopic triggers.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Kupusovic
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - M Weber
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - L Kessler
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - E Pesch
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - L Riesinger
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - R Wakili
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - D Dobrev
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - C Rischpler
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - T Rassaf
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - J Siebermair
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
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Kupusovic J, Kessler L, Ferdinandus J, Hirmas N, Fendler W, Totzeck M, Herrmann K, Wakili R, Rischpler C, Rassaf T, Siebermair J. Visualization of fibroblast activation after myocardial infarction using 68Ga-FAPI-PET. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Fibroblast activation protein (FAP) alpha specifically expressed by activated fibroblasts has been shown to be significantly involved in processes of tissue healing after injury, including fibrotic remodeling after myocardial infarction (MI). Positron-emission tomography (PET) with the tracer FAP-inhibitor (FAPI) is a novel diagnostic tool primarily described in oncologic patients for tumor stroma detection. We present data from a pilot study investigating patients after MI who underwent subsequent 68Ga-FAPI-PET for assessment of potential FAP-related myocardial remodeling.
Methods
In this retrospective study we analyzed a cohort of 10 post-MI patients who underwent 68Ga-FAPI-PET imaging with respect to cardiac tracer pattern. Standardized maximum and mean uptake values and total volume of tracer enrichment (fibroblast activation volume, FAV) of the infarcted area were calculated. A visual grading scale was established to assess the level of agreement between maximum localized tracer uptake and segments belonging to the supply area of the culprit vessel. Tracer uptake was correlated to clinical variables, with readers blinded to the clinical characteristics.
Results
Focal 68Ga-FAPI uptake was detected in all 10/10 patients after MI. According to our grading system for visual agreement of polar map segments and culprit lesion, we observed a very good (in 37.5% of patients) and a moderate (62.5% of patients) match between tracer uptake and the culprit lesion, respectively. We demonstrated a negative correlation of FAV uptake and left ventricular systolic function (R2=−0.69, p<0.05) and a very strong positive correlation of FAV and peak creatinine kinase level (R2=0.90, p<0.01).
Conclusion
Increased myocardial 68Ga-FAPI uptake, serving as a surrogate for FAP expression after MI, corresponds well to the supply area of the culprit coronary vessel as well as to biomarker levels of myocardial injury. This imaging technique represents a highly promising, novel bio-signal in the assessment of myocardial injury and consecutive remodeling. Large controlled studies are warranted to further evaluate the prognostic impact of this novel imaging technique.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Kupusovic
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - L Kessler
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - J Ferdinandus
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - N Hirmas
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - W Fendler
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - M Totzeck
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - K Herrmann
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - R Wakili
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - C Rischpler
- University Clinic Essen, Department of Nuclear Medicine, Essen, Germany
| | - T Rassaf
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - J Siebermair
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
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Siebermair J, Köhler MI, Kupusovic J, Nekolla SG, Kessler L, Ferdinandus J, Guberina N, Stuschke M, Grafe H, Siveke JT, Kochhäuser S, Fendler WP, Totzeck M, Wakili R, Umutlu L, Schlosser T, Rassaf T, Rischpler C. Cardiac fibroblast activation detected by Ga-68 FAPI PET imaging as a potential novel biomarker of cardiac injury/remodeling. J Nucl Cardiol 2021; 28:812-821. [PMID: 32975729 PMCID: PMC8249249 DOI: 10.1007/s12350-020-02307-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/14/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fibroblast activation protein (FAP) as a specific marker of activated fibroblasts can be visualized by positron emission tomography (PET) using Ga-68-FAP inhibitors (FAPI). Gallium-68-labeled FAPI is increasingly used in the staging of various cancers. In addition, the first cases of theranostic approaches have been reported. In this work, we describe the phenomenon of myocardial FAPI uptake in patients who received a Ga-68 FAPI PET for tumor staging. METHOD AND RESULTS Ga-68 FAPI PET examinations for cancer staging were retrospectively analyzed with respect to cardiac tracer uptake. Standardized uptake values (SUV) were correlated to clinical covariates in a univariate regression model. From 09/2018 to 11/2019 N = 32 patients underwent FAPI PET at our institution. Six out of 32 patients (18.8%) demonstrated increased localized myocardial tracer accumulation, with remote FAPI uptake being significantly higher in patients with vs without localized focal myocardial uptake (SUVmax 2.2 ± .6 vs 1.5 ± .4, P < .05 and SUVmean 1.6 ± .4 vs 1.2 ± .3, P < .05, respectively). Univariate regression demonstrated a significant correlation of coronary artery disease (CAD), age and left ventricular ejection fraction (LVEF) with remote SUVmean uptake, the latter with a very strong correlation with remote uptake (R2 = .74, P < .01). CONCLUSION Our study indicates an association of CAD, age, and LVEF with FAPI uptake. Further studies are warranted to assess if fibroblast activation can be reliably measured and may be used for risk stratification regarding early detection or progression of CAD and left ventricular remodeling.
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Affiliation(s)
- J Siebermair
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - M I Köhler
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J Kupusovic
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - S G Nekolla
- Department of Nuclear Medicine, School of Medicine, Technische Universität München, Munich, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - L Kessler
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J Ferdinandus
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - N Guberina
- Department of Radiotherapy, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M Stuschke
- Department of Radiotherapy, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - H Grafe
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J T Siveke
- Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - S Kochhäuser
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - W P Fendler
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - M Totzeck
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - R Wakili
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - L Umutlu
- University Hospital Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - T Schlosser
- University Hospital Essen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - T Rassaf
- Department of Cardiology and Vascular Medicine, University of Essen Medical School, West German Heart and Vascular Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - C Rischpler
- Department of Nuclear Medicine, Medical Faculty, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Rischpler C, Schlosser T, Umutlu L, Rassaf T, Krause BJ. [What actually happens … in hybrid imaging?]. Radiologe 2021; 60:1153-1161. [PMID: 33215289 DOI: 10.1007/s00117-020-00779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE The goal of this article is to shed light on innovations in perfusion imaging and the fields of application that have opened up in hybrid imaging of the heart. STANDARD RADIOLOGICAL METHODS As before, the most commonly used modalities in hybrid imaging are single photon emission computed tomography (SPECT) and positron emission tomography/computed tomography (PET/CT). Perfusion tracers and the radioactively labeled glucose analog 18F‑fluorodeoxyglucose (FDG) are commonly used for vitality imaging. METHODICAL INNOVATIONS Use of PET/MRI (magnetic resonance imaging) is becoming increasingly widespread. In addition, FDG is also increasingly applied in imaging infectious and inflammatory myocardial diseases. Furthermore, novel tracers are used, such as the amyloid-specific tracers in cardiac amyloidosis. PERFORMANCE Overall, this development has led to an increasing use of hybrid imaging techniques. These still include myocardial perfusion imaging, but are also used in inflammatory and infectious diseases such as endocarditis, myocarditis and sarcoidosis, as well as in underestimated diseases such as cardiac amyloidosis. The use of tracers has led to the creation of new fields of application in hybrid imaging. PRACTICAL RECOMMENDATIONS Hybrid imaging combining myocardial perfusion and coronary visualization seems to be particularly advantageous in complex cases such as multivessel disease. In infectious and inflammatory myocardial diseases, FDG PET/CT or PET/MRI has clearly demonstrated its added value. New fields of application are very promising, but their significance has yet to be clearly demonstrated.
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Affiliation(s)
- C Rischpler
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - T Schlosser
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - L Umutlu
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - T Rassaf
- Westdeutsches Herz- und Gefäßzentrum, Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - B J Krause
- Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Rostock, Rostock, Deutschland
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Michel L, Hendgen-Cotta U, Mincu R, Helfrich I, Korste S, Mrotzek S, Rischpler C, Herrmann K, Ugurel S, Zimmer L, Coman C, Ahrends R, Schadendorf D, Rassaf T, Totzeck M. Preclinical and clinical assessment of immune checkpoint inhibitor-associated left ventricular dysfunction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Immune checkpoint inhibitor (ICI) therapy has improved treatment of advanced cancers but is associated with yet incompletely characterized cardiotoxic side effects. While inflammatory cardiac complications were initially described as a rare phenomenon, emerging evidence indicates frequent cardiotoxicity, particularly latent left ventricular (LV) dysfunction. Distinct clinical characteristics and potential pathomechanisms are so far unknown.
Purpose
This study aims to investigate incidence and frequency of LV dysfunction in patients receiving ICI therapy for malignant melanoma. Using a suitable melanoma mouse model, ICI-related cardiotoxicity will be reenacted to identify potential underlying pathomechanisms.
Methods
Patients receiving ICI therapy for stage IV melanoma that presented in our cardio-oncology unit were evaluated at baseline and four weeks after initiation of therapy including echocardiography, cardiac biomarkers, and dobutamine stress echocardiography in the absence of contraindications. Patients with decreased LV ejection fraction (LVEF) were further evaluated by 18-fludeoxyglucose PET-MRI to assess manifest myocarditis. To elucidate underlying pathomechanisms, we established a melanoma mouse model that showed profound response to anti-programmed death 1 (PD1) ICI therapy. Immune cell infiltration was assessed by flow cytometry and light sheet fluorescence microscopy. Myocardial biochemical function was analyzed using a multi-omics mass spectrometry-based approach.
Results
Seven patients were included to the analysis. Six patients received a combination ICI therapy with ipilimumab and nivolumab, and one patient received nivolumab monotherapy. Echocardiography revealed significantly decreased 3D-LVEF after 4 weeks of therapy in treated patients (p=0.021). A reduced global longitudinal strain was found in six of seven patients. Remarkably, dobutamine stress echocardiography revealed a more pronounced LVEF-decrease (p=0.009) as a sign for impaired myocardial contractility with a mean decrease of 5 percentage points. Using the melanoma mouse model, we were able to recapitulate the disease phenotype as indicated by decreased LVEF and impaired response to inotropic stress during mouse pressure/volume catheterization. Increased concentrations of intramyocardial CD4+ and CD8+ T cells were found in mice treated with anti-PD1 ICI therapy compared to controls (p=0.01). Mass spectrometry revealed disrupted energy metabolism and calcium homeostasis as a putative underlying pathomechanism for impaired myocardial function.
Conclusions
ICI-related left ventricular dysfunction may affect a large proportion of patients and potentially increase cardiac morbidity and mortality. Preclinical data proposes myocardial lymphocyte infiltration and disruption of cardiomyocyte metabolism as the underlying pathomechanism. Prospective studies are now needed for a further characterization of this novel form of ICI-related cardiotoxicity.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): IFORES research grant, Medical Faculty, University Duisburg-Essen, Germany
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Affiliation(s)
- L Michel
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - U.B Hendgen-Cotta
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - R.I Mincu
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - I Helfrich
- University Hospital Essen, Department of Dermatology, Essen, Germany
| | - S Korste
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - S.M Mrotzek
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - C Rischpler
- University Hospital Essen, Department of Nuclear Medicine, Essen, Germany
| | - K Herrmann
- University Hospital Essen, Department of Nuclear Medicine, Essen, Germany
| | - S Ugurel
- University Hospital Essen, Department of Dermatology, Essen, Germany
| | - L Zimmer
- University Hospital Essen, Department of Dermatology, Essen, Germany
| | - C Coman
- University of Vienna, Institute for Analytical Chemistry, Vienna, Austria
| | - R Ahrends
- University of Vienna, Institute for Analytical Chemistry, Vienna, Austria
| | - D Schadendorf
- University Hospital Essen, Department of Dermatology, Essen, Germany
| | - T Rassaf
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - M Totzeck
- University of Duisburg-Essen - West-German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, Essen, Germany
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Baraliakos X, Tsiami S, Rischpler C, Bruckmann NM, Fendler W, Kirchner J, Hermann K, Sawicki L, Braun J. SAT0365 EFFECTS OF ANTI-TNF-THERAPY ON OSTEOBLASTIC ACTIVITY IN ANKYLOSING SPONDYLITIS – RESULTS FROM A PROSPECTIVE STUDY USING PET-MRI OF SIJ AND SPINE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The clinical efficacy of tumor necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA) is well established but its effect on new bone formation is still unclear (1). Positron emission tomography (PET) using bone-seeking18F-Fluoride [18F]F in combination with magnetic resonance imaging ([18F]F /MRI) has been shown to depict not only bone marrow edema (BME) but also shows the quantity of tracer uptake in the late phase of perfusion suggestive of remodeling and osteoblastic activity, not only in radiographic axSpA (r-axSpA) (2).Objectives:Assess the effect of TNFi on bone remodeling processes in the axial skeleton of r-axSpA patients using [18F]F/MRI prior (baseline, BL) and 4 months after (follow-up, FU) treatment.Methods:Patients (11 male, 5 female, mean age 38.6±12.0 years) with clinically active r-axSpA (BASDAI>4, failure of NSAIDs, no previous biologics) prospectively underwent 3-Tesla and [18F]F PET/MRI (40 minutes after injection of a mean activity of 157 MBq [18F]F). Images of the SIJ (n=16 patients) and the whole spine (n=10 patients) were performed at BL and FU. Three readers (1 for [18F]F/MRI and 2 for conventional MRI) evaluated all images independently and blinded to timepoint allocation. Only lesions on which all readers agreed on were used for further analyses. Inflammation (bone marrow edema, BME), structural lesions (fat deposition (FD), sclerosis, erosions and ankylosis) and focal [18F]F uptake were recorded on the level of SIJ (SIJ-Q) and vertebral quadrants (V-Q), with each SIJ or vertebral body consisting of 4 VQs (superior and inferior sacral and iliac for the SIJ, and superior and inferior, anterior and posterior for the vertebral bodies).Results:A total of 128 SIJ-Q and 920 VQs were analyzed at both BL and FU. In the SIJs, 75 (58.6%), 120 (93.8%), 69 (53.9%), 99 (77.3%) and 16 (12.5%) SIJ-Q showed BME, FD, sclerosis, erosions and ankylosis, while 111 (86.7%) SIJ-Q showed focal [18F]F-uptake at BL. Association with increased [18F]F-uptake was found most frequently in SIJ-Q with BME (70/75 SIJ-Q, 93.3%), sclerosis (65/69 SIJ-Q, 94.2%) and FD (105/120 SIJ-Q, 87.5%). At FU, 37 SIJ-Q still showed BME (improvement by 50.7%), while almost no changes were observed in chronic lesions. In comparison, improvement of focal [18F]F-uptake was found in all lesion combinations, with improvement of focal [18F]F-lesions associated with BME by 62.9%, with sclerosis by 33.8% and with FD by 22.9% of SIJ-Q.In the spine, only 41 (4.5%), 61 (6.6%), 14 (1.5%) V-Q showed BME, FD and sclerosis, respectively, while 77 V-Q (8.4%) showed focal [18F]F-uptake. An association to increased [18F]F-uptake was found most frequently with sclerosis (7/14 V-Q, 50%) and FD (25/61 V-Q, 41%). At FU, 12 V-Q still showed BME (improvement by 70.7%), while, similar to SIJ, almost no changes were observed in the chronic lesions. The largest improvement was found in focal [18F]F-lesions associated with BME 81.8% and with FD by 22.9% of V-Q.Conclusion:In this first prospective study on whole spine and SIJ [18F]F/MRI in patients with r-axSpA, a significant decrease of osteoblastic activity was observed over 4 months of continuous anti-TNF treatment. The effect of treatment was observed not only at sites with inflammatory lesions (BME) but also at sites with pre-existing chronic structural lesions, while some osteoblastic activity remained visible at 4 months. These data support a short-term effect of anti-TNF treatment on osteoblastic activity, while the long-term effects need to be further studied.References:[1]Van der Heijde D et al, Ann Rheum Dis 2017[2]Buchbender C et al, J Rheumatol 2015This work was supported by an unrestricted Grant by MSD GmbH, GermanyDisclosure of Interests:Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Styliani Tsiami: None declared, Christoph Rischpler: None declared, Nils-Martin Bruckmann: None declared, Wolfgang Fendler: None declared, Julian Kirchner: None declared, Ken Hermann: None declared, Lino Sawicki: None declared, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma
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Kessler L, Rischpler C. Single Tracer Combined Imaging: the Role of PET/MRI from Research Domain to Clinical Arena. Curr Cardiovasc Imaging Rep 2020. [DOI: 10.1007/s12410-020-09542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rischpler C, Ruhparwar A, Luedike P. Collateral damage: Imaging of long-term changes in perfusion and innervation following arterial switch-operation after transposition of the greater arteries. Int J Cardiol 2020; 300:299-300. [PMID: 31706625 DOI: 10.1016/j.ijcard.2019.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- C Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
| | - A Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Medical Faculty, University of Duisburg-Essen, Germany
| | - P Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Medical Faculty, University of Duisburg-Essen, Germany
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Affiliation(s)
- C Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - M Totzeck
- Department of Cardiology and Vascular Medicine, University Hospital Essen, West German Heart and Vascular Center, University of Duisburg, Essen, Germany
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Vitadello T, Rischpler C, Langwieser N, Kunze K, Nekolla S, Laugwitz KL, Schwaiger M, Ibrahim T. 5964Hybrid PET/MR imaging for the prediction of left ventricular (LV) recovery after revascularisation of chronic total occluded coronaries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents one of the major challenges in interventional cardiology. Physicians are still reluctant in referring for PCI, assuming non viability of the myocardium subtended by the CTO. Data are controversial in assessing the improvement of left ventricular (LV) wall motion after revascularisation and the prognostic value of viability testing to guide patient selection.
Purpose
The aim of this study was to determine, whether hybrid fluorodeoxyglucose positron emission tomography/magnetic resonance (FDG PET/MR) imaging allows a more accurate prediction of LV regional wall motion recovery after successful PCI of CTOs in comparison to PET or MR alone.
Methods
We enrolled 49 consecutive symptomatic patients with CTO and evidence of wall motion abnormality in the corresponding CTO-territory. All patients underwent hybrid FDG PET/MR imaging as semi-quantitative assessment of myocardial viability - glucose metabolism in PET and late gadolinium enhancement (LGE) transmurality in MR – prior of PCI of the CTO. Follow-up MRI was performed in 23 patients 3–6 months after successful revascularisation to evaluate wall motion changes.
Results
We assessed viability in 124 myocardial segments subtended by a CTO in 23 patients with successful PCI who underwent serial imaging. Segments with wall motion abnormality at baseline (n=80) were analysed. Most of these segments (n=54, 68%) were concordantly assessed viable by PET and MR, conversely only 2 (2%) segments were assessed non-viable by both imaging techniques. However, almost one third of the segments showed discordant patterns of viability either PET not viable/ MR viable (3 (4%) segments) or PET viable/ MR not viable (21 (26%) segments): particularly the latter revealed a significant wall motion improvement (p=0.033).
The combination of PET and MR showed a fair accuracy in predicting myocardial segments with wall motion improvement after CTO revascularisation (PET/MR area under ROC curve (AUC) 0.72, SE 0.07, p=0.002), which was superior to MR-LGE (AUC=0.66, SE 0.09) and FDG-PET (AUC=0.58, SE 0.10) alone (Figure).
Comparisons of ROC curves
Conclusion
Hybrid PET/MR imaging prior to successful CTO showed a better performance than PET or MR alone in predicting regional improvement of disturbed wall motion.
The complimentary information derived from both modalities may particularly help to identify small amounts of viable epicardial myocardium within large scars which can improve contractility after CTO-revascularisation.
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Affiliation(s)
| | - C Rischpler
- University Hospital of Essen (Ruhr), Essen, Germany
| | | | - K Kunze
- Hospital Rechts der Isar, Munich, Germany
| | - S Nekolla
- Hospital Rechts der Isar, Munich, Germany
| | | | | | - T Ibrahim
- Hospital Rechts der Isar, Munich, Germany
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15
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Rischpler C, Nekolla SG. Lost in quantification…: The influence of different software packages on flow quantification measures. J Nucl Cardiol 2019; 26:1255-1257. [PMID: 29340987 DOI: 10.1007/s12350-017-1159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- C Rischpler
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - S G Nekolla
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- C Rischpler
- Nuklearmedizinische Klinik des Klinikums Rechts der Isar, Technische Universität München, Munich, Germany.
| | - N Langwieser
- Medizinische Klinik des Klinikums Rechts der Isar, Technische Universität München, Munich, Germany
| | - S G Nekolla
- Nuklearmedizinische Klinik des Klinikums Rechts der Isar, Technische Universität München, Munich, Germany
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Nekolla SG, van Marwick S, Schachoff S, Kunze KP, Rischpler C. Cardiovascular PET/MRI: Technical Considerations and Outlook. Curr Cardiovasc Imaging Rep 2017. [DOI: 10.1007/s12410-017-9435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rischpler C, Nekolla SG, Kossmann H, Dirschinger RJ, Schottelius M, Hyafil F, Wester HJ, Laugwitz KL, Schwaiger M. Upregulated myocardial CXCR4-expression after myocardial infarction assessed by simultaneous GA-68 pentixafor PET/MRI. J Nucl Cardiol 2016; 23:131-3. [PMID: 26667813 DOI: 10.1007/s12350-015-0347-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Affiliation(s)
- C Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - S G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H Kossmann
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - R J Dirschinger
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - M Schottelius
- Pharmazeutische Radiochemie, Technische Universität München, Garching, Germany
| | - F Hyafil
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H J Wester
- Pharmazeutische Radiochemie, Technische Universität München, Garching, Germany
| | - K L Laugwitz
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - M Schwaiger
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Abstract
All along, translational cardiovascular research has been dependent on non-invasive imaging (such as single-photon emission computed tomography (SPECT), positron emission tomography (PET), computed tomography (CT), echocardiography, or magnetic resonance imaging (MRI)), as these techniques allow the assessment of surrogate markers in intact living organisms non-invasively. PET offers the advantages of high sensitivity; the capability for longitudinal, quantitative imaging; and that an armamentarium of promising radiotracers is readily available. All commercially available PET scanners are equipped with a CT component, and thus, the often cited disadvantage of a lack of morphologic correlation does not really count anymore. This review aims to give an outline on PET as a promising tool for translational research in cardiology as dedicated preclinical systems with virtually the same imaging features as those used in clinical imaging allows the straightforward concept of "bench to bedside."
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Affiliation(s)
- C Rischpler
- Nuklearmedizinische Klinik der TU München, Munchen, Germany,
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Taniguchi Y, Takahashi Y, Toba T, Yamada S, Yokoi K, Kobayashi S, Okajima S, Shimane A, Kawai H, Yasaka Y, Smanio P, Oliveira MA, Machado L, Cestari P, Medeiros E, Fukuzawa S, Okino S, Ikeda A, Maekawa J, Ichikawa S, Kuroiwa N, Yamanaka K, Igarashi A, Inagaki M, Patel K, Mahan M, Ananthasubramaniam K, Mouden M, Yokota S, Ottervanger J, Knollema S, Timmer J, Jager P, Padron K, Peix A, Cabrera L, Pena Bofill V, Valera D, Rodriguez Nande L, Carrillo Hernandez R, Mena Esnard E, Fernandez Columbie Y, Bertella E, Baggiano A, Mushtaq S, Segurini C, Loguercio M, Conte E, Beltrama V, Petulla' M, Andreini D, Pontone G, Guzic Salobir B, Dolenc Novak M, Jug B, Kacjan B, Novak Z, Vrtovec M, Mushtaq S, Pontone G, Bertella E, Conte E, Segurini C, Volpato V, Baggiano A, Formenti A, Pepi M, Andreini D, Ajanovic R, Husic-Selimovic A, Zujovic-Ajanovic A, Mlynarski R, Mlynarska A, Golba K, Sosnowski M, Ameta D, Goyal M, Kumar D, Chandra S, Sethi R, Puri A, Dwivedi SK, Narain VS, Saran RK, Nekolla S, Rischpler C, Nicolosi S, Langwieser N, Dirschinger R, Laugwitz K, Schwaiger M, Goral JL, Napoli J, Forcada P, Zucchiatti N, Damico A, Damico A, Olivieri D, Lavorato M, Dubesarsky E, Montana O, Salgado C, Jimenez-Heffernan A, Ramos-Font C, Lopez-Martin J, Sanchez De Mora E, Lopez-Aguilar R, Manovel A, Martinez A, Rivera F, Soriano E, Maroz-Vadalazhskaya N, Trisvetova E, Vrublevskaya O, Abazid R, Kattea M, Saqqah H, Sayed S, Smettei O, Winther S, Svensson M, Birn H, Jorgensen H, Botker H, Ivarsen P, Bottcher M, Maaniitty T, Stenstrom I, Saraste A, Pikkarainen E, Uusitalo V, Ukkonen H, Kajander S, Bax J, Knuuti J, Choi T, Park H, Lee C, Lee J, Seo Y, Cho Y, Hwang E, Cho D, Sanchez Enrique C, Ferrera C, Olmos C, Jimenez - Ballve A, Perez - Castejon MJ, Fernandez C, Vivas D, Vilacosta I, Nagamachi S, Onizuka H, Nishii R, Mizutani Y, Kitamura K, Lo Presti M, Polizzi V, Pino P, Luzi G, Bellavia D, Fiorilli R, Madeo A, Malouf J, Buffa V, Musumeci F, Rosales S, Puente A, Zafrir N, Shochat T, Mats A, Solodky A, Kornowski R, Lorber A, Boemio A, Pellegrino T, Paolillo S, Piscopo V, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Perrone-Filardi P, Cuocolo A, Piscopo V, Pellegrino T, Boemio A, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Petretta M, Cuocolo A, Amirov N, Ibatullin M, Sadykov A A, Saifullina G, Ruano R, Diego Dominguez M, Rodriguez Gabella T, Diego Nieto A, Diaz Gonzalez L, Garcia-Talavera J, Sanchez Fernandez P, Leen A, Al Younis I, Zandbergen-Harlaar S, Verberne H, Gimelli A, Veltman C, Wolterbeek R, Bax J, Scholte A, Mooney D, Rosenblatt J, Dunn T, Vasaiwala S, Okuda K, Nakajima K, Nystrom K, Edenbrandt L, Matsuo S, Wakabayashi H, Hashimoto M, Kinuya S, Iric-Cupic V, Milanov S, Davidovic G, Zdravkovic V, Ashikaga K, Yoneyama K, Akashi Y, Shugushev Z, Maximkin D, Chepurnoy A, Volkova O, Baranovich V, Faibushevich A, El Tahlawi M, Elmurr A, Alzubaidi S, Sakrana A, Gouda M, El Tahlawi R, Sellem A, Melki S, Elajmi W, Hammami H, Okano M, Kato T, Kimura M, Funasako M, Nakane E, Miyamoto S, Izumi T, Haruna T, Inoko M, Massardo T, Swett E, Fernandez R, Vera V, Zhindon J, Fernandez R, Swett E, Vera V, Zhindon J, Alay R, Massardo T, Ohshima S, Nishio M, Kojima A, Tamai S, Kobayashi T, Murohara T, Burrell S, Van Rosendael A, Van Den Hoogen I, De Graaf M, Roelofs J, Kroft L, Bax J, Scholte A, Rjabceva I, Krumina G, Kalvelis A, Chanakhchyan F, Vakhromeeva M, Kankiya E, Koppes J, Knol R, Wondergem M, Van Der Ploeg T, Van Der Zant F, Lazarenko SV, Bruin VS, Pan XB, Declerck JM, Van Der Zant FM, Knol RJJ, Juarez-Orozco LE, Alexanderson E, Slart R, Tio R, Dierckx R, Zeebregts C, Boersma H, Hillege H, Martinez-Aguilar M, Jordan-Rios A, Christensen TE, Ahtarovski KA, Bang LE, Holmvang L, Soeholm H, Ghotbi AA, Andersson H, Ihlemann N, Kjaer A, Hasbak P, Gulya M, Lishmanov YB, Zavadovskii K, Lebedev D, Stahle M, Hellberg S, Liljenback H, Virta J, Metsala O, Yla-Herttuala S, Saukko P, Knuuti J, Saraste A, Roivainen A, Thackeray J, Wang Y, Bankstahl J, Wollert K, Bengel F, Saushkina Y, Evtushenko V, Minin S, Efimova I, Evtushenko A, Smishlyaev K, Lishmanov Y, Maslov L, Okuda K, Nakajima K, Kirihara Y, Sugino S, Matsuo S, Taki J, Hashimoto M, Kinuya S, Ahmadian A, Berman J, Govender P, Ruberg F, Miller E, Piriou N, Pallardy A, Valette F, Cahouch Z, Mathieu C, Warin-Fresse K, Gueffet J, Serfaty J, Trochu J, Kraeber-Bodere F, Van Dijk J, Mouden M, Ottervanger J, Van Dalen J, Jager P, Zafrir N, Ofrk H, Vaturi M, Shochat T, Hassid Y, Belzer D, Sagie A, Kornowski R, Kaminek M, Metelkova I, Budikova M, Koranda P, Henzlova L, Sovova E, Kincl V, Drozdova A, Jordan M, Shahid F, Teoh Y, Thamen R, Hara N, Onoguchi M, Hojyo O, Kawaguchi Y, Murai M, Udaka F, Matsuzawa Y, Bulugahapitiya DS, Avison M, Martin J, Liu YH, Wu J, Liu C, Sinusas A, Daou D, Sabbah R, Bouladhour H, Coaguila C, Aguade-Bruix S, Pizzi M, Romero-Farina G, Candell-Riera J, Castell-Conesa J, Patchett N, Sverdlov A, Miller E, Daou D, Sabbah R, Bouladhour H, Coaguila C, Smettei O, Abazid R, Boulaamayl El Fatemi S, Sallam L, Snipelisky D, Park J, Ray J, Shapiro B, Kostkiewicz M, Szot W, Holcman K, Lesniak-Sobelga A, Podolec P, Clerc O, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Herzog B, Gaemperli O, Kaufmann P. Poster Session 1: Sunday 3 May 2015, 08:30-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Werner RA, Maya Y, Yamane T, Rischpler C, Fukushima K, Chen X, Lapa C, Herrmann K, Higuchi T, Thorn S, Stacy M, Purcell B, Doviak H, Shuman J, Perez E, Burdick J, Spinale F, Sinusas A, Treibel T, Bandula S, Fontana M, White S, Gilbertson J, Punwani S, Gillmore J, Hawkins P, Taylor S, Moon J, Caobelli F, Wollenweber T, Kuehn C, Bavendiek U, Schuetze C, Geworski L, Bauersachs J, Haverich A, Bengel F, Barysheva N, Merkulova I, Shabanova M, Gaman S, Veselova T, Shariya M, Kelion AD, Pakkal M, Chowdhury F, Nagaraj N, Birchall J, Dixon K, Banya W, Mccann G, Gershlick A, Rischpler C, Dirschinger R, Nicolosi S, Kossmann H, Meinicke A, Hanus F, Goetze K, Laugwitz K, Schwaiger M, Nekolla S, Rischpler C, Dirschinger R, Nicolosi S, Kossmann H, Meinicke A, Hanus F, Goetze K, Laugwitz K, Schwaiger M, Nekolla S. Moderated Poster Session 4: Monday 4 May 2015, 15:30-16:30 * Room: Moderated Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Langwieser N, von Olshausen G, Rischpler C, Ibrahim T. Confirmation of diagnosis and graduation of inflammatory activity of Loeffler endocarditis by hybrid positron emission tomography/magnetic resonance imaging. Eur Heart J 2014; 35:2496. [DOI: 10.1093/eurheartj/ehu148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
CLINICAL/METHODICAL ISSUE The positron emission tomography/magnetic resonance imaging (PET/MRI) technique represents a new hybrid imaging modality in nuclear cardiology. STANDARD RADIOLOGICAL METHODS The standard radiological method in this field is PET/computed tomography (CT). METHODICAL INNOVATIONS For morphological correlation MRI is used instead of CT. Furthermore, the creation of attenuation maps (μ-maps) has to be accomplished using MRI data. PERFORMANCE For this new hybrid imaging modality only limited data are so far available, especially in the field of nuclear cardiology; however, the available data show a relatively good agreement between both modalities with the PET/CT as the modality of reference. ACHIEVEMENTS In comparison to PET/CT a major advantage of PET/MRI is the lower radiation dose to the patient; however, the more complex workflow using this new imaging modality also has to be taken into account. Furthermore, some indications are still at an experimental stage using the PET/MRI. PRACTICAL RECOMMENDATIONS In daily practice, PET/MRI should be considered especially in younger patients due to the lower exposure to radiation. Furthermore, there are some advantages for this modality in the field of nuclear cardiology, such as imaging of inflammatory myocardial processes (e.g. cardiac sarcoidosis) or myocardial viability imaging.
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Affiliation(s)
- C Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Uebleis C, Groebner M, von Ziegler F, Becker A, Rischpler C, Tegtmeyer R, Becker C, Lehner S, Haug AR, Cumming P, Bartenstein P, Franz WM, Hacker M. Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery. Int J Cardiovasc Imaging 2011; 28:1763-74. [PMID: 22147107 DOI: 10.1007/s10554-011-9995-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/01/2011] [Indexed: 11/30/2022]
Abstract
There has been a lack of standardized workup guidelines for patients with congenital abnormal origin of a coronary artery from the opposite sinus (ACAOS). We aimed to evaluate the use of cardiac hybrid imaging using multi-detector row CT (MDCT) for coronary CT angiography (Coronary CTA) and stress-rest myocardial perfusion SPECT (MPS) for comprehensive diagnosis of symptomatic adult patients with ACAOS. Seventeen symptomatic patients (12 men; 54 ± 13 years) presenting with ACAOS underwent coronary CTA and MPS. Imaging data were analyzed by conventional means, and with additional use of 3D image fusion to allocate stress induced perfusion defects (PD) to their supplying coronary arteries. An anomalous RCA arose from the left anterior sinus in eight patients, an abnormal origin from the right sinus was detected in nine patients (5 left coronary arteries, LCA and 4 LCx). Five of the 17 patients (29%) demonstrated a reversible PD in MPS. There was no correlation between the anatomical variants of ACAOS and the presence of myocardial ischemia. Image fusion enabled the allocation of reversible PD to the anomalous vessel in three patients (two cases in the RCA and the other in the LCA territory); PD in two patients were allocated to the territory of artery giving rise to the anomalies, rather than the anomalies themselves. In a small cohort of adult symptomatic patients with ACAOS anomaly there was no relation found between the specific anatomical variant and the appearance of stress induced myocardial ischemia using cardiac hybrid imaging.
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Affiliation(s)
- C Uebleis
- Department of Nuclear Medicine, University of Munich, Marchioninistr 15, 81377 Munich, Germany
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