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F-18 fluorodeoxyglucose uptake and water-perfusable tissue fraction in assessment of myocardial viability.

Iida H, Ruotsalainen U, Mäki M, Haaparnata M, Bergman J, Voipio-Pulkki LM, Nuutila P, Koshino K, Knuuti J - Ann Nucl Med (2012)

Bottom Line: The image quality of (18)F-FDG was superior to that of (15)O-water.The qualitative PTF showed significantly smaller defects than (18)F-FDG, and the quantitative PTF showed slightly greater values than (18)F-FDG in the infarcted region.The absolute (18)F-FDG uptake was varied in normal segments, and predictive values for the wall motion recovery by the absolute (18)F-FDG was less (accuracy: 80 %) compared with those by the relative (18)F-FDG (accuracy: 87 %) and the quantitative PTF (accuracy: 89 %).

View Article: PubMed Central - PubMed

Affiliation: Turku PET Center, Turku University Central Hospital, 20520, Turku, Finland. iida@ri.ncvc.go.jp

ABSTRACT

Objectives: (15)O-water-perfusable tissue fraction (PTF) has been shown to be a potential index for assessing myocardial viability in PET, an alternative to (18)F-fluorodeoxyglucose (FDG). This study aimed to directly compare these two independent methods in assessing myocardial viability in patients with abnormal wall motion.

Methods: PET study was performed on 16 patients with previous myocardial infarction, before coronary artery bypass graft operation (CABG). The protocol included a (15)O-carbonmonoxide static, a (15)O-water dynamic and an (18)F-FDG dynamic scan, during the euglycemic hyperinsulinemic clamp. Echocardiography was performed at the time of PET and 5-12 months after the CABG, and the wall motion recovery was evaluated on segmental and global bases. Consistency between PTF and (18)F-FDG was evaluated visually and also in a quantitative manner. Predictive values for the wall motion recovery were also compared between the two approaches.

Results: The image quality of (18)F-FDG was superior to that of (15)O-water. The qualitative PTF showed significantly smaller defects than (18)F-FDG, and the quantitative PTF showed slightly greater values than (18)F-FDG in the infarcted region. The two methods were, however, consistent visually and also quantitatively. The predictive values of the wall motion recovery were almost equal between the two approaches. The absolute (18)F-FDG uptake was varied in normal segments, and predictive values for the wall motion recovery by the absolute (18)F-FDG was less (accuracy: 80 %) compared with those by the relative (18)F-FDG (accuracy: 87 %) and the quantitative PTF (accuracy: 89 %).

Conclusion: Despite the small sample size, PTF appears to give consistent results with the (18)F-FDG approach, and might be an alternative viability assessment.

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Relation between 18F-FDG uptake and absolute myocardial blood flow determined by means of 15O-water PET. Left: absolute uptake of 18F-FDG which was calculated using the arterial input function. Right: relative uptake of 18F-FDG to a control region. MBFt denotes ml of blood per minutes per ml of regions-of-interest adopted to this plot
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Fig3: Relation between 18F-FDG uptake and absolute myocardial blood flow determined by means of 15O-water PET. Left: absolute uptake of 18F-FDG which was calculated using the arterial input function. Right: relative uptake of 18F-FDG to a control region. MBFt denotes ml of blood per minutes per ml of regions-of-interest adopted to this plot

Mentions: Figure 3 shows the absolute and relative glucose uptake as a function of the absolute MBF, in which the flow per volume (i.e., the transmural flow) was adopted to the myocardial flow (i.e., the MBF estimated from the 15O-water kinetic analysis was multiplied by PTF) [10, 11, 13]. The variability of absolute glucose uptake from patient to patient was larger as compared to relative values. Thus, the relation was diverged at the normal MBF range. On the other hand, the relative 18F-FDG uptake which was normalized in each subject to the control segment was rather constant at the range: MBFt > 0.5 ml/min/ml. The relative 18F-FDG uptake showed a large variation at the range of MBFt between 0.3 and 0.5 ml/min/ml, and was decreased linearly with the MBFt for MBFt < 0.3 ml/min/ml. There was no significant correlation between absolute glucose uptake and PTF, while a significant correlation was observed if the relative 18F-FDG uptake was compared with PTF (p < 0.001) (Fig. 4).Fig. 3


F-18 fluorodeoxyglucose uptake and water-perfusable tissue fraction in assessment of myocardial viability.

Iida H, Ruotsalainen U, Mäki M, Haaparnata M, Bergman J, Voipio-Pulkki LM, Nuutila P, Koshino K, Knuuti J - Ann Nucl Med (2012)

Relation between 18F-FDG uptake and absolute myocardial blood flow determined by means of 15O-water PET. Left: absolute uptake of 18F-FDG which was calculated using the arterial input function. Right: relative uptake of 18F-FDG to a control region. MBFt denotes ml of blood per minutes per ml of regions-of-interest adopted to this plot
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Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475968&req=5

Fig3: Relation between 18F-FDG uptake and absolute myocardial blood flow determined by means of 15O-water PET. Left: absolute uptake of 18F-FDG which was calculated using the arterial input function. Right: relative uptake of 18F-FDG to a control region. MBFt denotes ml of blood per minutes per ml of regions-of-interest adopted to this plot
Mentions: Figure 3 shows the absolute and relative glucose uptake as a function of the absolute MBF, in which the flow per volume (i.e., the transmural flow) was adopted to the myocardial flow (i.e., the MBF estimated from the 15O-water kinetic analysis was multiplied by PTF) [10, 11, 13]. The variability of absolute glucose uptake from patient to patient was larger as compared to relative values. Thus, the relation was diverged at the normal MBF range. On the other hand, the relative 18F-FDG uptake which was normalized in each subject to the control segment was rather constant at the range: MBFt > 0.5 ml/min/ml. The relative 18F-FDG uptake showed a large variation at the range of MBFt between 0.3 and 0.5 ml/min/ml, and was decreased linearly with the MBFt for MBFt < 0.3 ml/min/ml. There was no significant correlation between absolute glucose uptake and PTF, while a significant correlation was observed if the relative 18F-FDG uptake was compared with PTF (p < 0.001) (Fig. 4).Fig. 3

Bottom Line: The image quality of (18)F-FDG was superior to that of (15)O-water.The qualitative PTF showed significantly smaller defects than (18)F-FDG, and the quantitative PTF showed slightly greater values than (18)F-FDG in the infarcted region.The absolute (18)F-FDG uptake was varied in normal segments, and predictive values for the wall motion recovery by the absolute (18)F-FDG was less (accuracy: 80 %) compared with those by the relative (18)F-FDG (accuracy: 87 %) and the quantitative PTF (accuracy: 89 %).

View Article: PubMed Central - PubMed

Affiliation: Turku PET Center, Turku University Central Hospital, 20520, Turku, Finland. iida@ri.ncvc.go.jp

ABSTRACT

Objectives: (15)O-water-perfusable tissue fraction (PTF) has been shown to be a potential index for assessing myocardial viability in PET, an alternative to (18)F-fluorodeoxyglucose (FDG). This study aimed to directly compare these two independent methods in assessing myocardial viability in patients with abnormal wall motion.

Methods: PET study was performed on 16 patients with previous myocardial infarction, before coronary artery bypass graft operation (CABG). The protocol included a (15)O-carbonmonoxide static, a (15)O-water dynamic and an (18)F-FDG dynamic scan, during the euglycemic hyperinsulinemic clamp. Echocardiography was performed at the time of PET and 5-12 months after the CABG, and the wall motion recovery was evaluated on segmental and global bases. Consistency between PTF and (18)F-FDG was evaluated visually and also in a quantitative manner. Predictive values for the wall motion recovery were also compared between the two approaches.

Results: The image quality of (18)F-FDG was superior to that of (15)O-water. The qualitative PTF showed significantly smaller defects than (18)F-FDG, and the quantitative PTF showed slightly greater values than (18)F-FDG in the infarcted region. The two methods were, however, consistent visually and also quantitatively. The predictive values of the wall motion recovery were almost equal between the two approaches. The absolute (18)F-FDG uptake was varied in normal segments, and predictive values for the wall motion recovery by the absolute (18)F-FDG was less (accuracy: 80 %) compared with those by the relative (18)F-FDG (accuracy: 87 %) and the quantitative PTF (accuracy: 89 %).

Conclusion: Despite the small sample size, PTF appears to give consistent results with the (18)F-FDG approach, and might be an alternative viability assessment.

Show MeSH
Related in: MedlinePlus