Cardiac Displacement During13N-Ammonia Myocardial Perfusion PET/CT: Comparison Between Adenosine- and Regadenoson-Induced Stress

Background: We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone.Methods: After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 � 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed.Results: CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect).Conclusions: Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.

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Splenic switch off as a novel marker for adenosine response in 13N-ammonia PET myocardial perfusion imaging – a pilot study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0289 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Bakula ◽

D Patriki ◽

E Von Felten ◽

G Benetos ◽

A Sustar ◽

...

Keyword(s):

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Contrast Agent ◽

Perfusion Imaging ◽

Microvascular Dysfunction ◽

Standard Uptake Value ◽

Funding Source ◽

National Budget ◽

Induced Stress ◽

Potential Marker

Abstract Background Positron emission tomography myocardial perfusion imaging (PET MPI) is a robust and excellent tool for assessing ischemia. So far, however, no methodology has been established to distinguish truly reduced MFR due to microvascular dysfunction or three-vessel coronary disease (CAD) from seemingly impaired MFR due to inadequate adenosine response. Conversely, for cardiac stress magnetic resonance (CMR) the adenosine induced splenic switch-off (SSO) sign has been proposed as a potential marker for adequate adenosine response. Purpose We assessed the feasibility of detecting SSO in adenosine stress 13N-ammonia PET MPI using SSO in CMR as the standard of reference. Methods 50 patients underwent simultaneous PET MPI and CMR on a hybrid PET/MR device with co-injection of 13N-ammonia and a gadolinium-based contrast agent during rest and adenosine-induced stress. In CMR, SSO was assessed qualitatively and quantitatively by calculating the ratio of the peak signal intensity of the spleen during stress over rest (SIR). Similarly, in PET MPI the splenic signal activity ratio (SAR) was calculated as the proportion of the maximal standard uptake value of the spleen in stress and rest. Additionally, MFR was quantified in PET MPI. Results Visual SSO in CMR was present in 37 (74%) patients, whereas 13 patients had no SSO. The median SIR in CMR was significantly lower in patients with visual SSO compared to patients without visual SSO (0.57 [IQR 0.49–0.62] vs. 0.89 [IQR 0.76–0.98]; p<0.001). Similarly, median SAR in PET was significantly lower in patients with visual SSO in CMR compared to patients without visual SSO (0.4 [IQR 0.32–0.45] vs. 0.8 [IQR 0.47–0.98]; p<0.001). SIR correlated significantly with SAR (r=0.4, p<0.05). Mean MFR was significantly higher in patients with visual SSO compared to patients without visual SSO (3.38±0.86 vs. 2.53±0.84; p<0.05). Conclusion Similarly to CMR, SSO can be detected in 13N-ammonia PET MPI. This might help distinguish adenosine non-responders from patients with truly impaired MFR due to microvascular dysfunction or multivessel CAD. Figure 1. Splenic switch off (*) illustrated on transaxial 13N-ammonia PET MPI stress (A) compared to rest perfusion images (B) and similarly in stress (C) and rest (D) short axis CMR (**) in the same patient during adenosine induced stress and co-injection of 13N-ammonia and a gadolinium based contrast agent, acquired on a hybrid PET/MR device. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation (SNSF)

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A NEW COMBINED APPROACH FOR ASSESSING CORONARY RESERVE AND MYOCARDIAL PERFUSION ACCORDING TO PET/CT IN THE DIAGNOSIS OF CORONARY ARTERY DISEASE

Russian Electronic Journal of Radiology ◽

10.21569/2222-7415-2020-10-3-46-57 ◽

2020 ◽

Vol 10 (3) ◽

pp. 46-57

Author(s):

I.P. Aslanidis ◽

◽

L.A. Bockeria ◽

M.G. Shavman ◽

I.V. Shurupova ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Perfusion ◽

Combined Approach ◽

Coronary Reserve ◽

Pet Ct ◽

Artery Disease

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Respiratory-motion errors in quantitative myocardial perfusion with PET/CT

2007 IEEE Nuclear Science Symposium Conference Record ◽

10.1109/nssmic.2007.4436981 ◽

2007 ◽

Cited By ~ 2

Author(s):

Maryna Shkvorets ◽

Robert A. deKemp ◽

R. Glenn Wells

Keyword(s):

Myocardial Perfusion ◽

Respiratory Motion ◽

Pet Ct ◽

Quantitative Myocardial Perfusion

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4778Impaired myocardial perfusion during atrial fibrillation in patients with non-ischaemic systolic heart failure - A cross-sectional study using Rubidium-82 PET/CT

European Heart Journal ◽

10.1093/eurheartj/ehx493.4778 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

C. Byrne ◽

P. Hasbak ◽

A. Kjaer ◽

J.J. Thune ◽

L. Koeber

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Myocardial Perfusion ◽

Systolic Heart Failure ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Pet Ct ◽

Rubidium 82

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Diagnostic accuracy of 13N-ammonia myocardial perfusion imaging with PET-CT in the detection of coronary artery disease

Cardiovascular Diagnosis and Therapy ◽

10.21037/cdt.2018.10.12 ◽

2019 ◽

Vol 9 (1) ◽

pp. 35-42 ◽

Cited By ~ 4

Author(s):

Ahmed Fathala ◽

Mervat Aboulkheir ◽

Mohamamed M. Shoukri ◽

Hani Alsergani

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Diagnostic Accuracy ◽

Perfusion Imaging ◽

Pet Ct ◽

Artery Disease

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Rubidium-82 PET/CT myocardial perfusion imaging

10.1016/b978-0-12-822960-6.00091-0 ◽

2021 ◽

Author(s):

Christel H. Kamani ◽

John O. Prior

Keyword(s):

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Perfusion Imaging ◽

Pet Ct ◽

Rubidium 82

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Relationship between epicardial adipose tissue and coronary vascular function in patients with suspected coronary artery disease and normal myocardial perfusion imaging

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez182 ◽

2019 ◽

Vol 20 (12) ◽

pp. 1379-1387 ◽

Cited By ~ 9

Author(s):

Carmela Nappi ◽

Andrea Ponsiglione ◽

Wanda Acampa ◽

Valeria Gaudieri ◽

Emilia Zampella ◽

...

Keyword(s):

Coronary Artery Disease ◽

Adipose Tissue ◽

Coronary Artery ◽

Myocardial Perfusion ◽

Vascular Function ◽

Epicardial Adipose Tissue ◽

Suspected Coronary Artery Disease ◽

Pet Ct ◽

Artery Disease ◽

The Relationship

Abstract Aims We evaluated the relationship between epicardial adipose tissue (EAT) and coronary vascular function assessed by rubidium-82 (82Rb) positron emission tomography/computed tomography (PET/CT) in patients with suspected coronary artery disease (CAD). Methods and results The study population included 270 patients with suspected CAD and normal myocardial perfusion at stress–rest 82Rb PET/CT. Coronary artery calcium (CAC) score and EAT volume were measured. Absolute myocardial blood flow (MBF) was computed in mL/min/ from the dynamic rest and stress imaging. Myocardial perfusion reserve (MPR) was defined as the ratio of hyperaemic to baseline MBF and it was considered reduced when <2. MPR was normal in 177 (65%) patients and reduced in 93 (35%). Patients with impaired MPR were older (P < 0.001) and had higher CAC score values (P = 0.033), EAT thickness (P = 0.009), and EAT volume (P < 0.001). At univariable logistic regression analysis, age, heart rate reserve (HRR), CAC score, EAT thickness, and EAT volume resulted significant predictors of reduced MPR, but only age (P = 0.002), HRR (P = 0.021), and EAT volume (P = 0.043) were independently associated with reduced MPR, at multivariable analysis. In patients with CAC score 0 (n = 114), a significant relation between EAT volume and MPR (P = 0.014) was observed, while the relationship was not significant (P = 0.21) in patients with CAC score >0 (n = 156). Conclusion In patients with suspected CAD and normal myocardial perfusion, EAT volume predicts hyperaemic MBF and reduced MPR, confirming that visceral pericardium fat may influence coronary vascular function. Thus, EAT evaluation has a potential role in the early identification of coronary vascular dysfunction.

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