1
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Schindler TH, Sadhu J. Moving towards PET determined coronary flow capacity in outcome prediction after coronary revascularization? Int J Cardiol 2024; 405:131921. [PMID: 38432610 DOI: 10.1016/j.ijcard.2024.131921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Justin Sadhu
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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2
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Bellofatto IA, Schindler TH, Portincasa P, Carbone F, Canepa M, Liberale L, Montecucco F. Early diagnosis and management of cardiac amyloidosis: A clinical perspective. Eur J Clin Invest 2024; 54:e14160. [PMID: 38217112 DOI: 10.1111/eci.14160] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024]
Abstract
Cardiac amyloidosis multidisciplinary team (MDT). We propose the creation of a multidisciplinary team (MDT) for cardiac amyloidosis in which internal medicine physicians could take a lead role in coordinating other specialists involved in patient care. Created with BioRender.com.
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Affiliation(s)
- Ilaria Anna Bellofatto
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, Bari, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino-Italian Cardiovascular Network, Genoa, Italy
| | - Marco Canepa
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino-Italian Cardiovascular Network, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino-Italian Cardiovascular Network, Genoa, Italy
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3
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Schindler TH. Atrial Metabolic Stress: Linking Metabolic Alterations and Atrial Fibrillation? JACC Basic Transl Sci 2024; 9:472-474. [PMID: 38680956 PMCID: PMC11055203 DOI: 10.1016/j.jacbts.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Thomas H. Schindler
- Division of Nuclear Medicine-Cardiovascular, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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4
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Valenta I, Schindler TH. PET-determined myocardial perfusion and flow in coronary artery disease characterization. J Med Imaging Radiat Sci 2024:S1939-8654(24)00023-7. [PMID: 38403519 DOI: 10.1016/j.jmir.2024.02.010] [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: 01/16/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Positron emission tomography (PET) myocardial perfusion imaging in conjunction with tracer-kinetic modeling enables the concurrent assessment of myocardial perfusion and regional myocardial blood flow (MBF) of the left ventricle in absolute terms in milliliters per gram per minute (mL/g/min). The non-invasive quantification of MBF during pharmacologically induced hyperemia, at rest, and corresponding myocardial flow reserve (MFR) opens a new avenue for the identification and characterization of classical or endogen type of coronary microvascular dysfunction (CMD) as functional substrate for microvascular angina in patients with non-obstructive coronary artery disease (CAD) and/or no CAD at all. Further, PET-MBF quantification expands the scope of conventional myocardial perfusion imaging from the identification of advanced, and flow-limiting, epicardial CAD to early stages of atherosclerosis and/or CMD. Adding MBF assessment to myocardial perfusion may also reliably unravel diffuse ischemia owing to significant left main stenosis and/or multivessel CAD, commonly confirmed by peak stress transient ischemic cavity dilation of the left ventricle during maximal vasomotor stress compared to rest on gated PET images. Owing to high spatial and contrast resolution in conjunction with photon-attenuation free myocardial perfusion PET images, PET is preferentially used for CAD detection in advanced obesity and women with pronounced breast habitus. With increasing clinical use of cardiac PET perfusion and MBF assessment, individualized, and image-guided cardiovascular treatment decisions in CAD patients is likely to ensue, while its translation into improved cardiovascular outcome remains to be investigated.
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Affiliation(s)
- Ines Valenta
- Washington University in St. Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, St. Louis, MO, USA
| | - Thomas H Schindler
- Washington University in St. Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, St. Louis, MO, USA.
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5
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Slart RHJA, Bengel FM, Akincioglu C, Bourque JM, Chen W, Dweck MR, Hacker M, Malhotra S, Miller EJ, Pelletier-Galarneau M, Packard RRS, Schindler TH, Weinberg RL, Saraste A, Slomka PJ. Total-Body PET/CT Applications in Cardiovascular Diseases: A Perspective Document of the SNMMI Cardiovascular Council. J Nucl Med 2024:jnumed.123.266858. [PMID: 38388512 DOI: 10.2967/jnumed.123.266858] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
Digital PET/CT systems with a long axial field of view have become available and are emerging as the current state of the art. These new camera systems provide wider anatomic coverage, leading to major increases in system sensitivity. Preliminary results have demonstrated improvements in image quality and quantification, as well as substantial advantages in tracer kinetic modeling from dynamic imaging. These systems also potentially allow for low-dose examinations and major reductions in acquisition time. Thereby, they hold great promise to improve PET-based interrogation of cardiac physiology and biology. Additionally, the whole-body coverage enables simultaneous assessment of multiple organs and the large vascular structures of the body, opening new opportunities for imaging systemic mechanisms, disorders, or treatments and their interactions with the cardiovascular system as a whole. The aim of this perspective document is to debate the potential applications, challenges, opportunities, and remaining challenges of applying PET/CT with a long axial field of view to the field of cardiovascular disease.
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Affiliation(s)
- Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Cigdem Akincioglu
- Division of Nuclear Medicine, Medical Imaging, Western University, London, Ontario, Canada
| | - Jamieson M Bourque
- Departments of Medicine (Cardiology) and Radiology, University of Virginia, Charlottesville, Virginia
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Edward J Miller
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut; Department of Radiology and Biomedical Imaging, Yale School of Medicine, and Department of Internal Medicine, Yale University, New Haven, Connecticut
| | | | - René R S Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Richard L Weinberg
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Antti Saraste
- Turku PET Centre and Heart Center, Turku University Hospital and University of Turku, Turku, Finland; and
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Schindler TH, Peterson LR. Sarcopenia and Coronary Microvascular Dysfunction: "Attention Must Be Paid". JACC Cardiovasc Imaging 2024; 17:192-194. [PMID: 37921723 DOI: 10.1016/j.jcmg.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Thomas H Schindler
- Washington University in St Louis, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, St Louis, Missouri, USA; Washington University in St Louis School of Medicine, John T. Milliken Department of Internal Medicine, Cardiovascular Division, St Louis, Missouri, USA.
| | - Linda R Peterson
- Washington University in St Louis School of Medicine, John T. Milliken Department of Internal Medicine, Cardiovascular Division, St Louis, Missouri, USA
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Jain S, Jain A, Schindler TH. Different Functional Outcome After Coronary Revascularization in Subacute and Chronic Hibernating Myocardium. JACC Cardiovasc Imaging 2024; 17:96-97. [PMID: 37632501 DOI: 10.1016/j.jcmg.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 08/28/2023]
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Montecucco F, Schindler TH. Future research with advanced imaging technology and biomarkers. Eur Heart J 2023; 44:5021-5023. [PMID: 37587554 DOI: 10.1093/eurheartj/ehad530] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa 16132, Italy
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8223, St. Louis, MO 63110, USA
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Chareonthaitawee P, Bateman TM, Beanlands RS, Berman DS, Calnon DA, Di Carli MF, Heller GV, Murthy VL, Patel KK, Schindler TH, Taqueti VR, Wiefels CC, Al-Mallah MH. Atlas for reporting PET myocardial perfusion imaging and myocardial blood flow in clinical practice: an information statement from the American Society of Nuclear Cardiology. J Nucl Cardiol 2023; 30:2850-2906. [PMID: 37889459 DOI: 10.1007/s12350-023-03378-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
| | - Timothy M Bateman
- Department of Cardiology, Saint-Luke's Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Rob S Beanlands
- Division of Cardiology, University of Ottawa, Ottawa, Canada
| | - Daniel S Berman
- Nuclear Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Ann Arbor, MI, USA
| | | | - Thomas H Schindler
- Department of Cardiovascular Diseases, Washington University Physicians, St. Louis, MO, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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Schindler TH, Fearon WF. Angiography-Derived FFR as Novel Parameter in Assessing Flow-Limiting CAD? JACC Cardiovasc Imaging 2023; 16:1332-1334. [PMID: 37115161 DOI: 10.1016/j.jcmg.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA.
| | - William F Fearon
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
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Lu DY, Yalcin H, Yalcin F, Sivalokanathan S, Greenland GV, Ventoulis I, Vakrou S, Pampaloni MH, Zimmerman SL, Valenta I, Schindler TH, Abraham TP, Abraham MR. Systolic blood pressure ≤110 mm Hg is associated with severe coronary microvascular ischemia and higher risk for ventricular arrhythmias in hypertrophic cardiomyopathy. Heart Rhythm O2 2023; 4:538-548. [PMID: 37744936 PMCID: PMC10513918 DOI: 10.1016/j.hroo.2023.07.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Coronary microvascular dysfunction (CMD) and hypertension (HTN) occur frequently in hypertrophic cardiomyopathy (HCM), but whether blood pressure (BP) influences CMD and outcomes is unknown. Objective The purpose of this study was to test the hypothesis that HTN is associated with worse CMD and outcomes. Methods This retrospective study included 690 HCM patients. All patients underwent cardiac magnetic resonance imaging, echocardiography, and rhythm monitoring; 127 patients also underwent rest/vasodilator stress 13NH3 positron emission tomography myocardial perfusion imaging. Patients were divided into 3 groups based on their rest systolic blood pressure (SBP) (group 1 ≤110 mm Hg; group 2 111-140; group 3 >140 mm Hg) and were followed for development of ventricular tachycardia (VT)/ventricular fibrillation (VF), heart failure (HF), death, and composite outcome. Results Group 1 patients had the lowest age and left ventricular (LV) mass but the highest prevalence of nonobstructive hemodynamics and restrictive diastolic filling. LV scar was similar in the 3 groups. Group 1 had the lowest rest and stress myocardial blood flow (MBF) and highest SDS (summed difference score). Rest SBP was positively correlated with stress MBF and negatively correlated with SDS. Group 1 had the highest incidence of VT/VF, whereas the incidences of HF, death, and composite outcome were similar among the 3 groups. In multivariate analysis, rest SBP ≤110 mm Hg was independently associated with VT/VF (hazard ratio 2.6; 95% confidence interval 1.0-6.7; P = .04). Conclusion SBP ≤110 mm Hg is associated with greater severity of CMD and coronary microvascular ischemia and higher incidence of ventricular arrhythmias in HCM.
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Affiliation(s)
- Dai-Yin Lu
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Hulya Yalcin
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Fatih Yalcin
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Sanjay Sivalokanathan
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Gabriela V. Greenland
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Ioannis Ventoulis
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Department of Occupational Therapy, University of Western Macedonia, Ptolemaida, Greece
| | - Styliani Vakrou
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
| | - Miguel Hernandez Pampaloni
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Ines Valenta
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Thomas H. Schindler
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Theodore P. Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - M. Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- Division of Cardiology, University of California San Francisco, San Francisco, California
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Ashrafinia S, Dalaie P, Schindler TH, Pomper MG, Rahmim A. Standardized Radiomics Analysis of Clinical Myocardial Perfusion Stress SPECT Images to Identify Coronary Artery Calcification. Cureus 2023; 15:e43343. [PMID: 37700937 PMCID: PMC10493172 DOI: 10.7759/cureus.43343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
PURPOSE Myocardial perfusion (MP) stress single-photon emission computed tomography (SPECT) is an established diagnostic test for patients suspected of coronary artery disease (CAD). Meanwhile, coronary artery calcification (CAC) scoring obtained from diagnostic CT is a highly sensitive test, offering incremental diagnostic information in identifying patients with significant CAD yet normal MP stress SPECT (MPSS) scans. However, after decades of wide utilization of MPSS, CAC is not commonly reimbursed (e.g. by the CMS), nor widely deployed in community settings. We studied the potential of complementary information deduced from the radiomics analysis of normal MPSS scans in predicting the CAC score. METHODS We collected data from 428 patients with normal (non-ischemic) MPSS (99mTc-sestamibi; consensus reading). A nuclear medicine physician verified iteratively reconstructed images (attenuation-corrected) to be free from fixed perfusion defects and artifactual attenuation. Three-dimensional images were automatically segmented into four regions of interest (ROIs), including myocardium and three vascular segments (left anterior descending [LAD]-left circumference [LCX]-right coronary artery [RCA]). We used our software package, standardized environment for radiomics analysis (SERA), to extract 487 radiomic features in compliance with the image biomarker standardization initiative (IBSI). Isotropic cubic voxels were discretized using fixed bin-number discretization (eight schemes). We first performed blind-to-outcome feature selection focusing on a priori usefulness, dynamic range, and redundancy of features. Subsequently, we performed univariate and multivariate machine learning analyses to predict CAC scores from i) selected radiomic features, ii) 10 clinical features, and iii) combined radiomics + clinical features. Univariate analysis invoked Spearman correlation with Benjamini-Hotchberg false-discovery correction. The multivariate analysis incorporated stepwise linear regression, where we randomly selected a 15% test set and divided the other 85% of data into 70% training and 30% validation sets. Training started from a constant (intercept) model, iteratively adding/removing features (stepwise regression), invoking the Akaike information criterion (AIC) to discourage overfitting. Validation was run similarly, except that the training output model was used as the initial model. We randomized training/validation sets 20 times, selecting the best model using log-likelihood for evaluation in the test set. Assessment in the test set was performed thoroughly by running the entire operation 50 times, subsequently employing Fisher's method to verify the significance of independent tests. RESULTS Unsupervised feature selection significantly reduced 8×487 features to 56. In univariate analysis, no feature survived the false-discovery rate (FDR) to directly correlate with CAC scores. Applying Fisher's method to the multivariate regression results demonstrated combining radiomics with the clinical features to enhance the significance of the prediction model across all cardiac segments. Conclusions: Our standardized and statistically robust multivariate analysis demonstrated significant prediction of the CAC score for all cardiac segments when combining MPSS radiomic features with clinical features, suggesting radiomics analysis can add diagnostic or prognostic value to standard MPSS for wide clinical usage.
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Affiliation(s)
- Saeed Ashrafinia
- Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Pejman Dalaie
- Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Martin G Pomper
- Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Arman Rahmim
- Physics and Astronomy, University of British Columbia, Vancouver, CAN
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13
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Yu Z, Rahman MA, Laforest R, Schindler TH, Gropler RJ, Wahl RL, Siegel BA, Jha AK. Need for objective task-based evaluation of deep learning-based denoising methods: A study in the context of myocardial perfusion SPECT. Med Phys 2023; 50:4122-4137. [PMID: 37010001 PMCID: PMC10524194 DOI: 10.1002/mp.16407] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Artificial intelligence-based methods have generated substantial interest in nuclear medicine. An area of significant interest has been the use of deep-learning (DL)-based approaches for denoising images acquired with lower doses, shorter acquisition times, or both. Objective evaluation of these approaches is essential for clinical application. PURPOSE DL-based approaches for denoising nuclear-medicine images have typically been evaluated using fidelity-based figures of merit (FoMs) such as root mean squared error (RMSE) and structural similarity index measure (SSIM). However, these images are acquired for clinical tasks and thus should be evaluated based on their performance in these tasks. Our objectives were to: (1) investigate whether evaluation with these FoMs is consistent with objective clinical-task-based evaluation; (2) provide a theoretical analysis for determining the impact of denoising on signal-detection tasks; and (3) demonstrate the utility of virtual imaging trials (VITs) to evaluate DL-based methods. METHODS A VIT to evaluate a DL-based method for denoising myocardial perfusion SPECT (MPS) images was conducted. To conduct this evaluation study, we followed the recently published best practices for the evaluation of AI algorithms for nuclear medicine (the RELAINCE guidelines). An anthropomorphic patient population modeling clinically relevant variability was simulated. Projection data for this patient population at normal and low-dose count levels (20%, 15%, 10%, 5%) were generated using well-validated Monte Carlo-based simulations. The images were reconstructed using a 3-D ordered-subsets expectation maximization-based approach. Next, the low-dose images were denoised using a commonly used convolutional neural network-based approach. The impact of DL-based denoising was evaluated using both fidelity-based FoMs and area under the receiver operating characteristic curve (AUC), which quantified performance on the clinical task of detecting perfusion defects in MPS images as obtained using a model observer with anthropomorphic channels. We then provide a mathematical treatment to probe the impact of post-processing operations on signal-detection tasks and use this treatment to analyze the findings of this study. RESULTS Based on fidelity-based FoMs, denoising using the considered DL-based method led to significantly superior performance. However, based on ROC analysis, denoising did not improve, and in fact, often degraded detection-task performance. This discordance between fidelity-based FoMs and task-based evaluation was observed at all the low-dose levels and for different cardiac-defect types. Our theoretical analysis revealed that the major reason for this degraded performance was that the denoising method reduced the difference in the means of the reconstructed images and of the channel operator-extracted feature vectors between the defect-absent and defect-present cases. CONCLUSIONS The results show the discrepancy between the evaluation of DL-based methods with fidelity-based metrics versus the evaluation on clinical tasks. This motivates the need for objective task-based evaluation of DL-based denoising approaches. Further, this study shows how VITs provide a mechanism to conduct such evaluations computationally, in a time and resource-efficient setting, and avoid risks such as radiation dose to the patient. Finally, our theoretical treatment reveals insights into the reasons for the limited performance of the denoising approach and may be used to probe the effect of other post-processing operations on signal-detection tasks.
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Affiliation(s)
- Zitong Yu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Md Ashequr Rahman
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robert J Gropler
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Abhinav K Jha
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
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Safiullah ZN, Latina JM, Ziogos E, Harb T, Schindler TH, Valenta-Schindler I, Alavi A, Gerstenblith G, Leucker TM. Novel Diagnostic Imaging Approach for Patients With Spontaneous Coronary Artery Dissection: The Utility of 18F-FDG PET Imaging. Clin Nucl Med 2023:00003072-990000000-00624. [PMID: 37385236 DOI: 10.1097/rlu.0000000000004762] [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] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
ABSTRACT Spontaneous coronary artery dissection (SCAD) is an underdiagnosed etiology of acute coronary syndrome in women. Accurate diagnosis remains challenging but is imperative for treatment and prevention. We show here the utility of 18F-FDG PET imaging in SCAD diagnosis. We present 1 representative case of 4 women with suspected SCAD on coronary angiography from the EVACS (Evolocumab in Acute Coronary Syndromes) clinical trial. 18F-FDG PET imaging showed acute inflammation in the distribution of the suspected dissected coronary artery identified on angiography. Localized myocardial inflammation identified on 18F-FDG PET imaging can aid in diagnosing SCAD suspected on coronary angiography.
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Affiliation(s)
| | - Jacqueline M Latina
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Efthymios Ziogos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tarek Harb
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St Louis, MO
| | - Ines Valenta-Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St Louis, MO
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thorsten M Leucker
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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15
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Bhandiwad AR, Valenta I, Jain S, Schindler TH. PET-determined prevalence of coronary microvascular dysfunction and different types in a cardio-metabolic risk population. Int J Cardiol Heart Vasc 2023; 46:101206. [PMID: 37113650 PMCID: PMC10127120 DOI: 10.1016/j.ijcha.2023.101206] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Background The aim was to investigate the prevalence of "classical" (predominantly related to alterations in hyperemic MBFs) and "endogen" (predominantly related to alterations in resting MBF) normal coronary microvascular function (nCMF) or coronary microvascular dysfunction (CMD) in a clinical population without flow-limiting obstructive CAD. Methods We prospectively enrolled 239 symptomatic patients with normal pharmacologically-stress and rest myocardial perfusion on 13N-ammonia PET/CT. 13N-ammonia PET/CT concurrently assessed myocardial flow reserve (MFR = MBF stress/MBF rest). Normal nCMF was defined by a MFR of ≥ 2.0, while an abnormal MFR of < 2.0 signified CMD. In addition, patients were subgrouped into classical and endogen type of nCMF and CMD, respectively. Results In the whole study population, CMD was present in 54% (130/239). The classical type was more prevalent than the endogen type of CMD (65% vs 35%, p ≤ 0.008). The classical type of CMD was paralleled by a high prevalence of diabetes mellitus, metabolic syndrome, and obesity, while the endogen type of CMD was accompanied by a higher prevalence of arterial hypertension, obesity, and/or morbid obesity. Further, the classical type of nCMF was more frequently observed that the endogen type (74% vs. 26%, p ≤ 0.007). The endogen type of nCMF was related to lower heart rate and/or arterial blood pressures. Conclusions In this contemporary clinical study population, slightly more than half of symptomatic patients had CMD with predominance of the classical type. These observations emphasize the need for standardized reporting of CMD to gear individualized and/or intensified medical treatment to improve symptoms and/or clinical outcome in these patients.
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Affiliation(s)
- Anita R. Bhandiwad
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Ines Valenta
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Sudhir Jain
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Thomas H. Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
- Corresponding author at: Washington University in St. Louis, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, 510 S. Kingshighway, Campus Box 8223, St. Louis, MO 63110, USA.
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16
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Du J, Sudlow LC, Shahverdi K, Zhou H, Michie M, Schindler TH, Mitchell JD, Mollah S, Berezin MY. Oxaliplatin-induced cardiotoxicity in mice is connected to the changes in energy metabolism in the heart tissue. bioRxiv 2023:2023.05.24.542198. [PMID: 37292714 PMCID: PMC10245950 DOI: 10.1101/2023.05.24.542198] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Oxaliplatin is a platinum-based alkylating chemotherapeutic agent used for cancer treatment. At high cumulative dosage, the negative effect of oxaliplatin on the heart becomes evident and is linked to a growing number of clinical reports. The aim of this study was to determine how chronic oxaliplatin treatment causes the changes in energy-related metabolic activity in the heart that leads to cardiotoxicity and heart damage in mice. C57BL/6 male mice were treated with a human equivalent dosage of intraperitoneal oxaliplatin (0 and 10 mg/kg) once a week for eight weeks. During the treatment, mice were followed for physiological parameters, ECG, histology and RNA sequencing of the heart. We identified that oxaliplatin induces strong changes in the heart and affects the heart's energy-related metabolic profile. Histological post-mortem evaluation identified focal myocardial necrosis infiltrated with a small number of associated neutrophils. Accumulated doses of oxaliplatin led to significant changes in gene expression related to energy related metabolic pathways including fatty acid (FA) oxidation, amino acid metabolism, glycolysis, electron transport chain, and NAD synthesis pathway. At high accumulative doses of oxaliplatin, the heart shifts its metabolism from FAs to glycolysis and increases lactate production. It also leads to strong overexpression of genes in NAD synthesis pathways such as Nmrk2. Changes in gene expression associated with energy metabolic pathways can be used to develop diagnostic methods to detect oxaliplatin-induced cardiotoxicity early on as well as therapy to compensate for the energy deficit in the heart to prevent heart damage.
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Affiliation(s)
- Junwei Du
- Mallinckrodt Institute of Radiology, Washington University School of Medicine St. Louis, MO 63110, USA
- Institute of Materials Science & Engineering Washington University, St. Louis, MO 63130, USA
| | - Leland C Sudlow
- Mallinckrodt Institute of Radiology, Washington University School of Medicine St. Louis, MO 63110, USA
| | - Kiana Shahverdi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine St. Louis, MO 63110, USA
| | - Haiying Zhou
- Mallinckrodt Institute of Radiology, Washington University School of Medicine St. Louis, MO 63110, USA
| | - Megan Michie
- Mallinckrodt Institute of Radiology, Washington University School of Medicine St. Louis, MO 63110, USA
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine St. Louis, MO 63110, USA
| | - Joshua D Mitchell
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO 63110
| | - Shamim Mollah
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110
| | - Mikhail Y Berezin
- Mallinckrodt Institute of Radiology, Washington University School of Medicine St. Louis, MO 63110, USA
- Institute of Materials Science & Engineering Washington University, St. Louis, MO 63130, USA
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17
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Schindler TH, Sivapackiam J, Sharma V. Emerging role of PET/MR in the diagnosis and characterization of cardiotoxicity? Int J Cardiol 2023:S0167-5273(23)00716-7. [PMID: 37201611 DOI: 10.1016/j.ijcard.2023.05.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/20/2023]
Abstract
In cardiotoxicity, PET/MR affords an accurate evaluation of cardiovascular morphology, function, and also multi-parametric tissue characterization. A composite of several cardiac imaging parameters provided by the PET/MR scanner is likely to outperform a single parameter or imaging modality in the assessment and prediction of the severity and progression of cardiotoxicity but needing clinical investigations. Of particular interest, a heterogeneity map of single PET and CMR parameters could be perfectly correlated with the PET/MR scanner likely emerging as a promising marker of cardiotoxicity to monitor treatment response. While such functional and structural multiparametric imaging approach with cardiac PET/MR in the assessment and characterization of cardiotoxicity holds much promise, its validity and value in cancer patients treated with chemotherapy and/or radiation still needs to be assessed. The multi-parametric imaging approach with PET/MR, however, is likely to set new standards to develop predictive constellations of parameters for the severity and potential progression of cardiotoxicity that should afford timely and individualized treatment intervention to ascertain myocardial recovery and improved clinical outcome in these high-risk patients.
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Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Jothilingam Sivapackiam
- Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, USA
| | - Vijay Sharma
- Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, USA
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18
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Fox JJ, Mauguen A, Ito K, Gupta D, Yu A, Schindler TH, Strauss HW, Schöder H. Long-Term Prognostic Value of 82Rb PET/CT-Determined Myocardial Perfusion and Flow Reserve in Cancer Patients. J Nucl Med 2023; 64:791-796. [PMID: 36604182 PMCID: PMC10152130 DOI: 10.2967/jnumed.122.264795] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Myocardial flow reserve (MFR), derived from quantitative measurements of myocardial blood flow during PET imaging, provides prognostic information on patients with coronary artery disease (CAD), but it is not known if this also applies to cancer patients with a competing risk for mortality. Methods: To determine the prognostic value of MFR in patients with cancer, we designed a retrospective cohort study comprising 221 patients with known or suspected CAD (median age, 71 y; range, 41-92 y) enrolled between June 2009 and January 2011. Most patients were referred for perioperative risk assessment. Patients underwent measurement of myocardial blood flow at rest and during pharmacologic stress, using quantitative 82Rb PET imaging. They were divided into early-stage versus advanced-stage cancer groups based on cancer histopathology and clinical state and were further stratified by myocardial perfusion summed stress score, summed difference score, and calculated MFR. Overall survival (OS) was assessed using the Kaplan-Meier estimator, and Cox proportional-hazards regression helped identify independent predictors for OS. Results: During a follow-up of 85.6 mo, 120 deaths occurred. MFR, summed difference score, and cancer stage were significantly associated with OS. In the age-adjusted Cox hazard multivariable analysis, MFR and cancer stage remained independent prognostic factors. MFR combined with cancer stage enhanced OS discrimination. The groups had significantly different outcomes (P < 0.001), with 5-y OS of 88% (MFR ≥ 1.97 and early-stage), 53% (MFR < 1.97 and early-stage), 33% (MFR ≥ 1.97 and advanced-stage), and 13% (MFR < 1.97 and advanced-stage). Conclusion: Independent of cancer stage, MFR derived from quantitative PET was prognostic of OS in our cohort of cancer patients with known or suspected CAD. Combining these 2 parameters enhanced discrimination of OS, suggesting that MFR improves risk stratification and may serve as a treatment target to increase survival in cancer patients.
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Affiliation(s)
- Josef J Fox
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kimiteru Ito
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Alice Yu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - H William Strauss
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
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19
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Yu Z, Rahman MA, Laforest R, Schindler TH, Gropler RJ, Wahl RL, Siegel BA, Jha AK. Need for Objective Task-based Evaluation of Deep Learning-Based Denoising Methods: A Study in the Context of Myocardial Perfusion SPECT. ArXiv 2023:2303.02110. [PMID: 36945690 PMCID: PMC10029054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Artificial intelligence-based methods have generated substantial interest in nuclear medicine. An area of significant interest has been using deep-learning (DL)-based approaches for denoising images acquired with lower doses, shorter acquisition times, or both. Objective evaluation of these approaches is essential for clinical application. DL-based approaches for denoising nuclear-medicine images have typically been evaluated using fidelity-based figures of merit (FoMs) such as RMSE and SSIM. However, these images are acquired for clinical tasks and thus should be evaluated based on their performance in these tasks. Our objectives were to (1) investigate whether evaluation with these FoMs is consistent with objective clinical-task-based evaluation; (2) provide a theoretical analysis for determining the impact of denoising on signal-detection tasks; (3) demonstrate the utility of virtual clinical trials (VCTs) to evaluate DL-based methods. A VCT to evaluate a DL-based method for denoising myocardial perfusion SPECT (MPS) images was conducted. The impact of DL-based denoising was evaluated using fidelity-based FoMs and AUC, which quantified performance on detecting perfusion defects in MPS images as obtained using a model observer with anthropomorphic channels. Based on fidelity-based FoMs, denoising using the considered DL-based method led to significantly superior performance. However, based on ROC analysis, denoising did not improve, and in fact, often degraded detection-task performance. The results motivate the need for objective task-based evaluation of DL-based denoising approaches. Further, this study shows how VCTs provide a mechanism to conduct such evaluations using VCTs. Finally, our theoretical treatment reveals insights into the reasons for the limited performance of the denoising approach.
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20
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Schindler TH, Bhandiwad AR, Jain S. Role of cardiac magnetic resonance imaging in the prediction of left ventricular remodeling after infarction: Emerging new concepts? Int J Cardiol 2023; 374:127-128. [PMID: 36640961 DOI: 10.1016/j.ijcard.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Anita R Bhandiwad
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Sudhir Jain
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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21
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Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Cardiovascular Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8223, St Louis, MO 63110, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, 4921 Parkview Plaza, St. Louis, MO 63110, USA
| | - Ines Valenta
- Division of Nuclear Medicine, Cardiovascular Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8223, St Louis, MO 63110, USA
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22
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Schindler TH, Jain S, Bhandiwad AR. Assessment of coronary anatomy and flow for optimized diagnosis and prognostication in CAD. Eur Heart J Cardiovasc Imaging 2023; 24:312-313. [PMID: 36617212 DOI: 10.1093/ehjci/jeac267] [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] [Indexed: 01/09/2023] Open
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8223, St. Louis, MO 63110, USA.,John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, 4921 Parkview Plaza, St. Louis, MO 63110, USA
| | | | - Anita R Bhandiwad
- John T. Milliken Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, 4921 Parkview Plaza, St. Louis, MO 63110, USA
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23
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Schindler TH, Bhandiwad A. Coronary Microvascular Dysfunction: Linking Inflammation and Cardiac Dysfunction? JACC Basic Transl Sci 2023; 8:152-154. [PMID: 36908668 PMCID: PMC9998456 DOI: 10.1016/j.jacbts.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Thomas H Schindler
- Washington University in St. Louis School of Medicine, Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, St. Louis, Missouri, USA
| | - Anita Bhandiwad
- Washington University in St. Louis School of Medicine, John T. Milliken Department of Internal Medicine, Cardiovascular Division, St. Louis, Missouri, USA
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24
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Schindler TH, Fearon WF, Pelletier-Galarneau M, Ambrosio G, Sechtem U, Ruddy TD, Patel KK, Bhatt DL, Bateman TM, Gewirtz H, Shirani J, Knuuti J, Gropler RJ, Chareonthaitawee P, Slart RHJA, Windecker S, Kaufmann PA, Abraham MR, Taqueti VR, Ford TJ, Camici PG, Schelbert HR, Dilsizian V. PET for Detection and Reporting Coronary Microvascular Dysfunction: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2023; 16:536-548. [PMID: 36881418 DOI: 10.1016/j.jcmg.2022.12.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/14/2022] [Accepted: 12/02/2022] [Indexed: 02/11/2023]
Abstract
Angina pectoris and dyspnea in patients with normal or nonobstructive coronary vessels remains a diagnostic challenge. Invasive coronary angiography may identify up to 60% of patients with nonobstructive coronary artery disease (CAD), of whom nearly two-thirds may, in fact, have coronary microvascular dysfunction (CMD) that may account for their symptoms. Positron emission tomography (PET) determined absolute quantitative myocardial blood flow (MBF) at rest and during hyperemic vasodilation with subsequent derivation of myocardial flow reserve (MFR) affords the noninvasive detection and delineation of CMD. Individualized or intensified medical therapies with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, angiotensin II type 1-receptor blockers, beta-blockers, ivabradine, or ranolazine may improve symptoms, quality of life, and outcome in these patients. Standardized diagnosis and reporting criteria for ischemic symptoms caused by CMD are critical for optimized and individualized treatment decisions in such patients. In this respect, it was proposed by the cardiovascular council leadership of the Society of Nuclear Medicine and Molecular Imaging to convene thoughtful leaders from around the world to serve as an independent expert panel to develop standardized diagnosis, nomenclature and nosology, and cardiac PET reporting criteria for CMD. This consensus document aims to provide an overview of the pathophysiology and clinical evidence of CMD, its invasive and noninvasive assessment, standardization of PET-determined MBFs and MFR into "classical" (predominantly related to hyperemic MBFs) and "endogen" (predominantly related to resting MBF) normal coronary microvascular function or CMD that may be critical for diagnosis of microvascular angina, subsequent patient care, and outcome of clinical CMD trials.
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Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
| | - William F Fearon
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Giuseppe Ambrosio
- University of Perugia School of Medicine Ospedale S. Maria della Misericordia Perugia, Italy
| | - Udo Sechtem
- Cardiologicum Stuttgart, Stuttgart, Baden-Wuerttemberg, Germany
| | | | - Krishna K Patel
- Icahn School of Medicine at Mount Sinai, Zena, New York, New York, USA; Michael A. Wiener Cardiovascular Institute, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Timothy M Bateman
- Saint-Lukes Health System and the Mid-America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Henry Gewirtz
- Cardiac Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jamshid Shirani
- Cardiology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Robert J Gropler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | | | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Maria R Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, California, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thomas J Ford
- The University of Newcastle, Faculty of Medicine, Newcastle, Australia
| | - Paolo G Camici
- San Raffaele Hospital, Milan Italy; Vita Salute University, Milan, Italy
| | - Heinrich R Schelbert
- Department of Molecular Imaging and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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25
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Ruddy TD, Al-Mallah M, Arrighi JA, Bois JP, Bluemke DA, Di Carli MF, Dilsizian V, Gropler RJ, Jadvar H, Malhotra S, Pelletier-Galarneau M, Schindler TH, Woodard PK, Chareonthaitawee P. SNMMI/ACR/ASNC/SCMR Joint Credentialing Statement for Cardiac PET/MRI: Endorsed by the American Heart Association. J Nucl Med 2023; 64:149-152. [PMID: 36599473 PMCID: PMC9841259 DOI: 10.2967/jnumed.122.264200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/27/2022] [Accepted: 04/22/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
| | | | - James A. Arrighi
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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26
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Brier MR, Hamdi M, Rajamanikam J, Zhao H, Mansor S, Jones LA, Rahmani F, Jindal S, Koudelis D, Perlmutter JS, Wong DF, Nickels M, Ippolito JE, Gropler RJ, Schindler TH, Laforest R, Tu Z, Benzinger TLS. Phase 1 Evaluation of 11C-CS1P1 to Assess Safety and Dosimetry in Human Participants. J Nucl Med 2022; 63:1775-1782. [PMID: 35332093 PMCID: PMC9635683 DOI: 10.2967/jnumed.121.263189] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/02/2022] [Indexed: 01/07/2023] Open
Abstract
This study evaluated the safety, dosimetry, and characteristics of 3-((2-fluoro-4-(5-(2'-methyl-2-(trifluoromethyl)-[1,1'-biphenyl]-4-yl)-1,2,4-oxadiazol-3-yl)benzyl)(methyl-11C)amino)propanoic acid (11C-CS1P1), a radiotracer targeting sphingosine-1-phosphate receptor (S1PR) 1 (S1PR1). S1PR1 is of clinical interest because of its role in multiple sclerosis (and other conditions), with an expanding class of S1PR modulators approved for relapsing multiple sclerosis. 11C-CS1P1 binds S1PR1 with high specificity and has shown promise in animal models of inflammatory diseases. Methods: 11C-CS1P1 was injected into 5 male and 6 female healthy participants. Ten participants were imaged with PET using a multipass whole-body continuous-bed-motion acquisition, and one had dedicated head and neck PET and MRI. Participants were continuously monitored for safety events. Organ time-activity curve data were collected, integrated, and normalized to the injected activity. Organ radiation doses and effective dose were computed using the adult male and female models in OLINDA, version 2.2. SUV images were evaluated for qualitative biodistribution. Results: No adverse events were observed after the dose, including no bradycardia. The liver was the critical organ from dosimetry analysis (mean ± SD: female, 23.12 ± 5.19 μSv/MBq; male, 21.06 ± 1.63 μSv/MBq). The whole-body effective dose (as defined by International Commission on Radiological Protection publication 103) was 4.18 ± 0.30 μSv/MBq in women and 3.54 ± 0.14 μSv/MBq in men. Using a maximum delivered dose of 740 MBq (20 mCi), the effective dose for women would be 3.1 mSv (0.31 rem), with a liver dose of 17.1 mSv (1.7 rem); the effective dose for men would be 2.6 mSv (0.26 rem), with a liver dose of 15.6 mSv (1.56 rem). Brain uptake was seen predominantly in gray matter and correlated with regional S1PR1 RNA expression (r = 0.84). Conclusion: These results support the safety of 11C-CS1P1 for evaluation of inflammation in human clinical populations. Dosimetry permits repeated measures in the same participants. Brain uptake correlates well with known target topography.
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Affiliation(s)
- Matthew R Brier
- Department of Neurology, Washington University, St. Louis, Missouri
| | - Mahdjoub Hamdi
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | | | - Haiyang Zhao
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Syahir Mansor
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Lynne A Jones
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Farzaneh Rahmani
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Saurabh Jindal
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Deborah Koudelis
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Joel S Perlmutter
- Department of Neurology, Washington University, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
- Department of Neuroscience, Washington University, St. Louis, Missouri
- Department of Physical and Occupational Therapy, Washington University, St. Louis, Missouri; and
| | - Dean F Wong
- Department of Neurology, Washington University, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
- Department of Neuroscience, Washington University, St. Louis, Missouri
- Department of Psychiatry, Washington University, St. Louis, Missouri
| | - Michael Nickels
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Robert J Gropler
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Zhude Tu
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri;
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri;
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27
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Schindler TH, Valenta I, Dilsizian V. Disturbances in Brain-Heart Neuronal-Metabolic Axis Are Associated With Major Arrhythmic Events in Heart Failure. J Am Coll Cardiol 2022; 80:1897-1899. [DOI: 10.1016/j.jacc.2022.09.014] [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] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022]
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28
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Ruddy TD, Al-Mallah M, Arrighi JA, Bois JP, Bluemke DA, Di Carli MF, Dilsizian V, Gropler RJ, Jadvar H, Malhotra S, Pelletier-Galarneau M, Schindler TH, Woodard PK, Chareonthaitawee P. SNMMI/ACR/ASNC/SCMR Joint Credentialing Statement for Cardiac PET/MRI: Endorsed by the American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014576. [PMID: 35920160 PMCID: PMC9384825 DOI: 10.1161/circimaging.122.014576] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | - James A. Arrighi
- Warren Alpert Medical School of Brown University, Providence, RI (J.A.A.)
| | | | | | | | | | - Robert J. Gropler
- Washington University School of Medicine, St. Louis, MO (R.J.G., T.H.S., P.K.W.)
| | - Hossein Jadvar
- University of Southern California, Los Angeles, CA (H.J.)
| | | | | | - Thomas H. Schindler
- Washington University School of Medicine, St. Louis, MO (R.J.G., T.H.S., P.K.W.)
| | - Pamela K. Woodard
- Washington University School of Medicine, St. Louis, MO (R.J.G., T.H.S., P.K.W.)
| | - Panithaya Chareonthaitawee
- Mayo Clinic, Rochester, MN (J.P.B., P.C.)
- Correspondence to: Panithaya Chareonthaitawee, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email
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29
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Ruddy TD, Al-Mallah M, Arrighi JA, Bois JP, Bluemke DA, Di Carli MF, Dilsizian V, Gropler RJ, Jadvar H, Malhotra S, Pelletier-Galarneau M, Schindler TH, Woodard PK, Chareonthaitawee P. SNMMI/ACR/ASNC/SCMR joint credentialing statement for cardiac PET/MRI. J Cardiovasc Magn Reson 2022; 24:43. [PMID: 35850721 PMCID: PMC9295497 DOI: 10.1186/s12968-022-00867-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - James A Arrighi
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - John P Bois
- Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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30
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Schindler TH, Haq A, Jain S. Added value gated PET with phase analysis for the detection of scar burden and prognostication in cardiac sarcoidosis? J Nucl Cardiol 2022; 29:1402-1404. [PMID: 33502697 DOI: 10.1007/s12350-021-02530-z] [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: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA.
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - Adeel Haq
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA
| | - Sudhir Jain
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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31
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Vavuranakis MA, Jones SR, Ziogos E, Blaha MJ, Williams MS, Foran P, Schindler TH, Lai S, Schulman SP, Gerstenblith G, Leucker TM. The Trajectory of Lipoprotein(a) During the Peri- and Early Postinfarction Period and the Impact of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibition. Am J Cardiol 2022; 171:1-6. [PMID: 35314069 DOI: 10.1016/j.amjcard.2022.01.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
Lipoprotein(a), or Lp(a), levels and the effect of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition on Lp(a) during the peri-infarction and early postinfarction period are not well characterized. This study aimed to describe the trajectory of Lp(a), as well as the effect of PCSK9 inhibition on that trajectory during the peri-infarction and early postinfarction period. Lp(a) levels were obtained within 24 hours of hospital admission as well as within 24 hours of hospital discharge and at 30 days from 74 participants who presented with a NSTEMI (troponin I >5 ng/ml) or with a STEMI and were enrolled in 2 randomized, double-blind trials of evolocumab and placebo (Evolocumab in Acute Coronary Syndrome [EVACS I]; ClinicalTrials.gov, NCT03515304 and Evolocumab in Patients With STEMI [EVACS II]; ClinicalTrials.gov Identifier: NCT04082442). There was a significant increase from the pretreatment level in the placebo-treated patients, from 64 (41,187) nmol/L to 80 (47, 172) nmol/L at hospital discharge and to 82 (37, 265) at 30 days. This was primarily driven by the results from participants with high Lp(a) at hospital admission (>75 nmol/L) in whom the median increase was 28% as compared with a 10% increase in those with pretreatment Lp(a) of <75 nmol/L. In contrast, there was no significant change from the pretreatment level in the evolocumab-treated patients regardless of pretreatment Lp(a) levels. In conclusion, Lp(a) rises during the peri-infarction and early postinfarction period in patients with acute myocardial infarction. The increase was prevented by a single dose of subcutaneous evolocumab given within 24 hours of hospital admission.
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32
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El Ghannudi S, Ouvrard E, Mikail N, Leroy Freschini B, Schindler TH, Imperiale A. Cutting-Edge Imaging of Cardiac Metastases from Neuroendocrine Tumors: Lesson from a Case Series. Diagnostics (Basel) 2022; 12:diagnostics12051182. [PMID: 35626337 PMCID: PMC9139778 DOI: 10.3390/diagnostics12051182] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022] Open
Abstract
With the increasing availability of high-performance medical imaging for the management of patients with neuroendocrine tumors (NETs), a progressive growth of asymptomatic and incidentally detected cardiac metastases (CMs) has been observed in the recent years. In clinical practice, CMs of NENs are often incidentally detected by whole-body 68Ga-labeled somatostatin analogs or 18F-fluorodihydroxyphenylalanine positron emission tomography/computed tomography, and afterwards accurately characterized by cardiac magnetic resonance (CMR) and/or gated cardiac computed tomography when CMR is contraindicated or not available. The interpreting physician should familiarize with the main imaging features of CM, a finding that may be encountered in NETs patients more than previously thought. Herein, we present a case series of four patients with CMs from small-intestine NETs highlighting strengths and weaknesses of a multimodality imaging approach in clinical practice.
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Affiliation(s)
- Soraya El Ghannudi
- Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67093 Strasbourg, France; (E.O.); (B.L.F.)
- Department of Radiology, University Hospitals of Strasbourg, 67098 Strasbourg, France
- Correspondence: (S.E.G.); (A.I.)
| | - Eric Ouvrard
- Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67093 Strasbourg, France; (E.O.); (B.L.F.)
| | - Nidaa Mikail
- Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital (APHP), 92110 Clichy, France;
| | - Benjamin Leroy Freschini
- Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67093 Strasbourg, France; (E.O.); (B.L.F.)
| | - Thomas H. Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA;
| | - Alessio Imperiale
- Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67093 Strasbourg, France; (E.O.); (B.L.F.)
- Molecular Imaging—DRHIM, IPHC, UMR 7178, CNRS/Unistra, 67093 Strasbourg, France
- Correspondence: (S.E.G.); (A.I.)
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33
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Schindler TH, Valenta I. Another Step Toward Integrated MR/PET as Favored Imaging Modality in Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2022; 15:457-459. [PMID: 35272810 DOI: 10.1016/j.jcmg.2021.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, Missouri, USA.
| | - Ines Valenta
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, Missouri, USA
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34
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Schindler TH, Varney B, Jain S. Molecular imaging of active coronary micro-calcification with 18F-NaF and PET: emergence of a new biomarker of the vulnerable atherosclerotic plaque? Eur J Prev Cardiol 2021; 28:e6-e7. [PMID: 33611388 DOI: 10.1177/2047487320912627] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, USA
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, USA
| | - Brittany Varney
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, USA
| | - Sudhir Jain
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, USA
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35
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Schindler TH, Felder G. Emergence of 18F-FDG positron emission tomography in the detection and characterization of cardiac implantable device infections. J Nucl Cardiol 2021; 28:3004-3006. [PMID: 32743753 DOI: 10.1007/s12350-020-02260-8] [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: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Washington University School of Medicine, Mallinckrodt Institute of Radiology, 510 S. Kingshighway, St. Louis, MO, 63110, USA.
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Gabriel Felder
- Division of Nuclear Medicine, Washington University School of Medicine, Mallinckrodt Institute of Radiology, 510 S. Kingshighway, St. Louis, MO, 63110, USA
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36
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Schindler TH, Jain S. 123I-MIBG cardiac sympathetic imaging provides further insight into cardiorenal interactions in systolic heart failure patients. J Nucl Cardiol 2021; 28:2123-2125. [PMID: 31875284 DOI: 10.1007/s12350-019-01993-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA.
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Sudhir Jain
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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37
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Schindler TH, Leucker TM, Bhandiwad A. Entering a new era of the identification and characterization of myocardial ischemic burden with 15O-water PET? Int J Cardiol 2021; 341:22-23. [PMID: 34329679 DOI: 10.1016/j.ijcard.2021.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Thorsten M Leucker
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Anita Bhandiwad
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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38
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Schindler TH, Sharma V, Bhandiwad A. Cardiac computed tomography-derived extracellular volume fraction in the identification of cardiotoxicity: Another emerging imaging option. Int J Cardiol Heart Vasc 2021; 34:100806. [PMID: 34141861 PMCID: PMC8188043 DOI: 10.1016/j.ijcha.2021.100806] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Vijay Sharma
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, MO, USA
| | - Anita Bhandiwad
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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39
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Juengling FD, Maldonado A, Wuest F, Schindler TH. Identify. Quantify. Predict. Why Immunologists Should Widely Use Molecular Imaging for Coronavirus Disease 2019. Front Immunol 2021; 12:568959. [PMID: 34054793 PMCID: PMC8155634 DOI: 10.3389/fimmu.2021.568959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/16/2021] [Indexed: 01/18/2023] Open
Abstract
Molecular imaging using PET/CT or PET/MRI has evolved from an experimental imaging modality at its inception in 1972 to an integral component of diagnostic procedures in oncology, and, to lesser extent, in cardiology and neurology, by successfully offering in-vivo imaging and quantitation of key pathophysiological targets or molecular signatures, such as glucose metabolism in cancerous disease. Apart from metabolism probes, novel radiolabeled peptide and antibody PET tracers, including radiolabeled monoclonal antibodies (mAbs) have entered the clinical arena, providing the in-vivo capability to collect target-specific quantitative in-vivo data on cellular and molecular pathomechanisms on a whole-body scale, and eventually, extract imaging biomarkers possibly serving as prognostic indicators. The success of molecular imaging in mapping disease severity on a whole-body scale, and directing targeted therapies in oncology possibly could translate to the management of Coronavirus Disease 2019 (COVID-19), by identifying, localizing, and quantifying involvement of different immune mediated responses to the infection with SARS-COV2 during the course of acute infection and possible, chronic courses with long-term effects on specific organs. The authors summarize current knowledge for medical imaging in COVID-19 in general with a focus on molecular imaging technology and provide a perspective for immunologists interested in molecular imaging research using validated and immediately available molecular probes, as well as possible future targets, highlighting key targets for tailored treatment approaches as brought up by key opinion leaders.
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Affiliation(s)
- Freimut D. Juengling
- Medical Faculty, University Bern, Bern, Switzerland
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Antonio Maldonado
- Department of Nuclear Medicine and Molecular Imaging, Quironsalud Madrid University Hospital, Madrid, Spain
| | - Frank Wuest
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Thomas H. Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, Saint Louis, MO, United States
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40
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Pretet V, Blondet C, Ruch Y, Martinez M, El Ghannudi S, Morel O, Hansmann Y, Schindler TH, Imperiale A. Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis. Diagnostics (Basel) 2021; 11:diagnostics11040720. [PMID: 33919643 PMCID: PMC8073326 DOI: 10.3390/diagnostics11040720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/29/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as "possible" or "rejected" IE despite a persisting high level of clinical suspicion. Herein, we evaluate the 18F-FDG PET/CT diagnostic and therapeutic impact in IE suspicion, with emphasis on possible/rejected IE with a high clinical suspicion. Excluding cases of definite IE diagnosis, 53 patients who underwent 18F-FDG PET/CT for IE suspicion were selected and afterwards classified according to both mDC (possible IE/Duke 1, rejected IE/Duke 0) and clinical suspicion degree (high and low IE suspicion). The final status regarding IE diagnosis (gold standard) was based on the multidisciplinary decision of the Endocarditis Team, including the 'imaging specialist'. PET/CT images of the cardiac area were qualitatively interpreted and the intensity of each focus of extra-physiologic 18F-FDG uptake was evaluated by a maximum standardized uptake value (SUVmax) measurement. Extra-cardiac 18F-FDG PET/CT pathological findings were considered to be a possible embolic event, a possible source of IE, or even a concomitant infection. Based on the Endocarditis Team consensus, final diagnosis of IE was retained in 19 (36%) patients and excluded in 34 (64%). With a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and global accuracy of 79%, 100%, 100%, 89%, and 92%, respectively, PET/CT performed significantly better than mDC (p = 0.003), clinical suspicion degree (p = 0.001), and a combination of both (p = 0.001) for IE diagnosis. In 41 patients with possible/rejected IE but high clinical suspicion, sensitivity, specificity, PPV, NPV, and global accuracies were 78%, 100%, 100%, 85%, and 90%, respectively. Moreover, PET/CT contributed to patient management in 24 out of 53 (45%) cases. 18F-FDG PET/CT represents a valuable diagnostic tool that could be proposed for challenging IE cases with significant differences between mDC and clinical suspicion degree. 18F-FDG PET/CT allows a binary diagnosis (definite or rejected IE) by removing uncertain diagnostic situations, thus improving patient therapeutic management.
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Affiliation(s)
- Valentin Pretet
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
| | - Cyrille Blondet
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
| | - Yvon Ruch
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
- Infectious Diseases, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Matias Martinez
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Nuclear Medicine and Molecular Imaging, Oulton Institute, 5000 Cordoba, Argentina
- Nuclear Medicine, Hospital Privado Universitario, 5000 Cordoba, Argentina
| | - Soraya El Ghannudi
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Radiology, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Olivier Morel
- Cardiology, University Hospitals of Strasbourg, 67000 Strasbourg, France;
| | - Yves Hansmann
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
- Infectious Diseases, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Thomas H. Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University, St Louis, MO 63110, USA;
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
- Molecular Imaging–DRHIM, IPHC, UMR 7178, CNRS, 67037 Strasbourg, France
- Correspondence: ; Tel.: +33-368-767-448; Fax: +33-368-767-256
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41
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Schindler TH, Bhandiwad A. Cardiac Magnetic Resonance Determined T1 Reactivity Holds Promise for a New Avenue of Coronary Circulatory Function Characterization. Circ Cardiovasc Imaging 2021; 14:e012429. [PMID: 33706539 DOI: 10.1161/circimaging.121.012429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine (T.H.S.), Washington University in St. Louis School of Medicine, St. Louis, MO.,Mallinckrodt Institute of Radiology and Cardiovascular Division, John T. Milliken Department of Internal Medicine (T.H.S. and A.B.). Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Anita Bhandiwad
- Mallinckrodt Institute of Radiology and Cardiovascular Division, John T. Milliken Department of Internal Medicine (T.H.S. and A.B.). Washington University in St. Louis School of Medicine, St. Louis, MO
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42
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Lu L, Eldeniz C, An H, Li R, Yang Y, Schindler TH, Peterson LR, Woodard PK, Zheng J. Quantification of myocardial oxygen extraction fraction: A proof-of-concept study. Magn Reson Med 2021; 85:3318-3325. [PMID: 33497013 DOI: 10.1002/mrm.28673] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To demonstrate a proof of concept for the measurement of myocardial oxygen extraction fraction (mOEF) by a cardiovascular magnetic resonance technique. METHODS The mOEF measurement was performed using an electrocardiogram-triggered double-echo asymmetric spin-echo sequence with EPI readout. Seven healthy volunteers (22-37 years old, 5 females) were recruited and underwent the same imaging scans at rest on 2 different days for reproducibility assessment. Another 5 subjects (23-37 years old, 4 females) underwent cardiovascular magnetic resonance studies at rest and during a handgrip isometric exercise with a 25% of maximal voluntary contraction. Both mOEF and myocardial blood volume values were obtained in septal regions from respective maps. RESULTS The reproducibility was excellent for the measurements of mOEF in septal myocardium (coefficient of variation: 3.37%) and moderate for myocardial blood volume (coefficient of variation: 19.7%). The average mOEF and myocardial blood volume of 7 subjects at rest were 0.61 ± 0.05 and 11.0 ± 4.3%, respectively. The mOEF agreed well with literature values that were measured by PET in healthy volunteers. In the exercise study, there was no significant change in mOEF (0.61 ± 0.06 vs 0.62 ± 0.07) or myocardial blood volume (12 ± 6% vs 13 ± 4%) from rest to exercise, as expected. CONCLUSION The implemented cardiovascular magnetic resonance method shows potential for the quantitative assessment of mOEF in vivo. Future technical work is needed to improve image quality and to further validate mOEF measurements.
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Affiliation(s)
- Lillian Lu
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ran Li
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yang Yang
- Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Linda R Peterson
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Schindler TH, Derenoncourt P, Leucker TM. Cardiac sarcoidosis and prediction of sudden death: An ongoing clinical dilemma? Int J Cardiol 2020; 329:177-178. [PMID: 33358833 DOI: 10.1016/j.ijcard.2020.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Paul Derenoncourt
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Thorsten M Leucker
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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44
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Schindler TH, Leucker T. Revival of an old stressor: Dobutamine-stimulation for PET myocardial perfusion imaging in patients with end-stage liver disease? J Nucl Cardiol 2020; 27:2060-2062. [PMID: 30515744 DOI: 10.1007/s12350-018-01543-5] [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: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA.
| | - Thorsten Leucker
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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45
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Lu DY, Yalçin H, Sivalokanathan S, Greenland GV, Vasquez N, Yalçin F, Zhao M, Valenta I, Ganz P, Pampaloni MH, Zimmerman S, Schindler TH, Abraham TP, Abraham MR. Higher incidence of vasodilator-induced left ventricular cavity dilation by PET when compared to treadmill exercise-ECHO in hypertrophic cardiomyopathy. J Nucl Cardiol 2020; 27:2031-2043. [PMID: 30456498 DOI: 10.1007/s12350-018-01521-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vasodilator-induced transient left ventricular cavity dilation (LVCD) by positron emission tomography (PET) is associated with microvascular dysfunction in hypertrophic cardiomyopathy (HCM). Here we assessed whether HCM patients who develop LVCD by PET during vasodilator stress also develop LV cavity dilation by echocardiography (ECHO-LVCD) following exercise stress. METHODS A retrospective analysis of cardiac function and myocardial blood flow (MBF) was conducted in 108 HCM patients who underwent perfusion-PET and exercise-ECHO as part of their clinical evaluation. We performed a head-to-head comparison of LV volumes and ejection fraction (LVEF) at rest and stress (during vasodilator stress, post-exercise), in 108 HCM patients. A ratio > 1.13 of stress to rest LV volumes was used to define PET-LVCD, and a ratio > 1.17 of stress to rest LVESV was used to define ECHO-LVCD. Patients were divided into 2 groups based on the presence/absence of PET-LVCD. MBF and myocardial flow reserve were quantified by PET, and global longitudinal strain (GLS) was assessed by ECHO at rest/stress in the two groups. RESULTS PET-LVCD was observed in 51% (n = 55) of HCM patients, but only one patient had evidence of ECHO-LVCD (ratio = 1.36)-this patient also had evidence of PET-LVCD (ratio = 1.20). The PET-LVCD group had lower PET-LVEF during vasodilator stress, but ECHO-LVEF increased in both groups post-exercise. The PET-LVCD group demonstrated higher LV mass, worse GLS at rest/stress, and lower myocardial flow reserve. Incidence of ischemic ST-T changes was higher in the PET-LVCD group during vasodilator stress (42 vs 17%), but similar (30%) in the two groups during exercise. CONCLUSION PET-LVCD reflects greater degree of myopathy and microvascular dysfunction in HCM. Differences in the cardiac effects of exercise and vasodilators and timing of stress-image acquisition could underlie discordance in ischemic EKG changes and LVCD by ECHO and PET, in HCM.
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Affiliation(s)
- Dai-Yin Lu
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hulya Yalçin
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA
| | - Sanjay Sivalokanathan
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA
| | - Gabriela V Greenland
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA
- Division of Cardiology, University of California San Francisco, 555 Mission Bay Blvd South, Smith Cardiovascular Research Building, 452K, San Francisco, CA, 94158, USA
| | - Nestor Vasquez
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA
| | - Fatih Yalçin
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA
| | - Min Zhao
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ines Valenta
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Ganz
- Division of Cardiology, University of California San Francisco, 555 Mission Bay Blvd South, Smith Cardiovascular Research Building, 452K, San Francisco, CA, 94158, USA
| | - Miguel Hernandez Pampaloni
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | - Stefan Zimmerman
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas H Schindler
- Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Theodore P Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA
- Division of Cardiology, University of California San Francisco, 555 Mission Bay Blvd South, Smith Cardiovascular Research Building, 452K, San Francisco, CA, 94158, USA
| | - M Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, MD, USA.
- Division of Cardiology, University of California San Francisco, 555 Mission Bay Blvd South, Smith Cardiovascular Research Building, 452K, San Francisco, CA, 94158, USA.
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46
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Schindler TH, Bateman TM, Berman DS, Chareonthaitawee P, De Blanche LE, Dilsizian V, Dorbala S, Gropler RJ, Shaw L, Soman P, Winchester DE, Verberne H, Ahuja S, Beanlands RS, Di Carli MF, Murthy VL, Ruddy TD, Schwartz RG. Appropriate Use Criteria for PET Myocardial Perfusion Imaging. J Nucl Med 2020; 61:1221-1265. [PMID: 32747510 DOI: 10.2967/jnumed.120.246280] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | - Daniel S Berman
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Panithaya Chareonthaitawee
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia
| | | | - Vasken Dilsizian
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia
| | - Sharmila Dorbala
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Robert J Gropler
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Leslee Shaw
- American College of Cardiology, Washington, D.C.,Society of Cardiovascular Computed Tomography, Arlington, Virginia
| | - Prem Soman
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American College of Cardiology, Washington, D.C
| | | | - Hein Verberne
- European Association of Nuclear Medicine, Vienna, Austria
| | - Sukhjeet Ahuja
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Rob S Beanlands
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Nuclear Cardiology, Fairfax, Virginia.,American College of Cardiology, Washington, D.C.,Canadian Society of Cardiovascular Nuclear and CT Imaging, Ottawa, Ontario, Canada.,Canadian Cardiovascular Society, Ottawa, Ontario, Canada; and
| | - Marcelo F Di Carli
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Heart Association, Dallas, Texas
| | | | - Terrence D Ruddy
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,Canadian Society of Cardiovascular Nuclear and CT Imaging, Ottawa, Ontario, Canada.,Canadian Cardiovascular Society, Ottawa, Ontario, Canada; and
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47
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Schindler TH, Sharma V, Imperiale A. 18F-Florbetaben and PET/CT Holds Promise for the Identification and Differentiation Among Cardiac Amyloidosis Entities. JACC Cardiovasc Imaging 2020; 14:256-258. [PMID: 32771579 DOI: 10.1016/j.jcmg.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
| | - Vijay Sharma
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Alessio Imperiale
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France
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48
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Schindler TH, Valenta I. Relative disagreement among different software packages in PET-flow quantitation: An appeal for consistency. J Nucl Cardiol 2020; 27:1234-1236. [PMID: 30903607 DOI: 10.1007/s12350-019-01633-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Thomas H Schindler
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA.
| | - Ines Valenta
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA
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49
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Leucker TM, Blaha MJ, Jones SR, Vavuranakis MA, Williams MS, Lai H, Schindler TH, Latina J, Schulman SP, Gerstenblith G. Effect of Evolocumab on Atherogenic Lipoproteins During the Peri- and Early Postinfarction Period: A Placebo-Controlled, Randomized Trial. Circulation 2020; 142:419-421. [PMID: 32718248 DOI: 10.1161/circulationaha.120.046320] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Thorsten M Leucker
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Michael J Blaha
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Steven R Jones
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Michael A Vavuranakis
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Marlene S Williams
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Hong Lai
- Department of Radiology, Johns Hopkins University School of Medicine (H.L.), Baltimore, Maryland
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, Washington University in St. Louis, MO (T.H.S.)
| | - Jacqueline Latina
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Steven P Schulman
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
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50
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Abstract
Purpose of Review Currently, cardiotoxicity is monitored through echocardiography or multigated acquisition scanning and is defined as 10% or higher LVEF reduction. The latter stage may represent irreversible myocardium injury and limits modification of therapeutic paradigms at earliest stages. To stratify patients for anthracycline-related heart failure, highly sensitive and molecularly specific probes capable of interrogating cardiac damage at the subcellular levels have been sought. Recent Findings PET tracers may provide noninvasive assessment of earliest changes within myocardium. These tracers are at nascent stages of development and belong primarily to (a) mitochondrial potential-targeted and (b) general ROS (reactive oxygen species)-targeted radiotracers. Given that electrochemical gradient changes at the mitochondrial membrane represent an upstream, and earliest event before triggering the production of the ROS and caspase activity in a biochemical cascade, the former category might offer interrogation of cardiotoxicity at earliest stages exemplified by PET imaging, using 18F-Mitophos and 68Ga-Galmydar in rodent models. Summary Both categories of radiotracers may provide tools for monitoring chemotherapy-induced cardiotoxicity and interrogating therapeutic efficacy of cardio-protectants.
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Affiliation(s)
- Jothilingam Sivapackiam
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, PO Box 8225, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Monica Sharma
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, PO Box 8225, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, PO Box 8225, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA.,Departments of Medicine, Cardiology and Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Vijay Sharma
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, PO Box 8225, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA. .,Department of Biomedical Engineering, School of Engineering & Applied Science, Washington University, St. Louis, MO, 63105, USA.
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