The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

PET and PET/CT in Clinical Cardiology

심장 PET과 PET/CT의 임상적 이용

  • Won, Kyoung-Sook (Department of Nuclear Medicine, Keimyung University School of Medicine)
  • 원경숙 (계명대학교 의과대학 핵의학교실)
  • Published : 2005.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Cardiac PET emerged as a powerful tool that allowed in vivo quantification of physiologic processes including myocardial perfusion and metabolism, as well as neuronal and receptor function for more than 25 years. Wow PET imaging has been playing an important role in the clinical evaluation of patients with known or suspected ischemic heart disease. This important clinical role is expected to grow with the availability of PET/CT scanner that allow a true integration of structure and function. The objective of this review is to provide an update on the current and future role of PET in clinical cardiology with a special eye on the great opportunities now offered by PET/CT.

Keywords

References

  1. Townsend DW, Beyer T. A combined PET/CT scanner: the path to true image fusion. Br J Radiol 2002;75:S24-30
  2. Campisi R, Di Carli MF. Assessment of coronary flow reserve and microcirculation: a clinical perspective. J Nucl Cardiol 2004;11: 3-11 https://doi.org/10.1016/j.nuclcard.2003.11.003
  3. Schindler TH, Hornig B, Buser PT, Olschewski M, Magosaki N, Pfisterer M, et al. Prognostic value of abnormal vasoreactivity of epicardial coronary arteries to sympathetic stimulation in patients with normal coronary angiograms. Arterioscler Thromb Vasc Biol 2003;23:495-501 https://doi.org/10.1161/01.ATV.0000057571.03012.F4
  4. Schindler TH, Nitzsche EU, Munzel T, Olschewski M, Brink I, Jeserich M, et al. Coronary vasoregulation in patients with various risk factors in response to cold pressor testing: contrasting myocardial blood flow responses to short- and long-term vitamin C administration. J Am Coll Cardiol 2003;42:814-22 https://doi.org/10.1016/S0735-1097(03)00851-9
  5. Halcox JP, Schenke WH, Zalos G, Mincemoyer R, Prasad A, Waclawiw MA, et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation 2002;106:653-8 https://doi.org/10.1161/01.CIR.0000025404.78001.D8
  6. Schachinger V, Zeiher AM. Prognostic implications of endothelial dysfunction: does it mean anything? Coron Artery Dis 2001;12:435- 443 https://doi.org/10.1097/00019501-200109000-00002
  7. Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation 2002;106:974-80 https://doi.org/10.1161/01.CIR.0000027560.41358.B3
  8. Baller D, Notohamiprodjo G, Gleichmann U, Holzinger J, Weise R, Lehmann J. Improvement in coronary flow reserve determined by positron emission tomography after 6 months of cholesterol lowering therapy in patients with early stages of coronary atherosclerosis. Circulation 1999;99:2871-5 https://doi.org/10.1161/01.CIR.99.22.2871
  9. Janatuinen T, Laaksonen R, Vesalainen R, Raitakari O, Lehtimaki T, Nuutila P, et al. Effect of lipid-lowering therapy with pravastatin on myocardial blood flow in young mildly hypercholesterolemic adults. J Cardiovasc Pharmacol 2001;38:561-568 https://doi.org/10.1097/00005344-200110000-00008
  10. Guethlin M, Kasel AM, Coppenrath K, Ziegler S, Delius W, Schwaiger M. Delayed response of myocardial flow reserve to lipid-lowering therapy with fluvastatin. Circulation 1999;99:475-81 https://doi.org/10.1161/01.CIR.99.4.475
  11. Huggins GS, Pasternak RC, Alpert NM, Fischman AJ, Gewirtz H. Effects of short-term treatment of hyperlipidemia on coronary vasodilator function and myocardial perfusion in regions having substantial impairment of baseline dilator reverse. Circulation 1998;98:1291-6 https://doi.org/10.1161/01.CIR.98.13.1291
  12. Yokoyama I, Yonekura K, Inoue Y, Ohtomo K, Nagai R. Longterm effect of simvastatin on the improvement of impaired myocardial flow reserve in patients with familial hypercholesterolemia without gender variance. J Nucl Cardiol 2001;8:445-51 https://doi.org/10.1067/mnc.2001.115517
  13. Go RT, Marwick TH, MacIntyre WJ, Saha GB, Neumann DR, Underwood DA, et al. A prospective comparison of rubidium-82 PET and thallium-201 SPECT myocardial perfusion imaging utilizing a single dipyridamole stress in the diagnosis of coronary artery disease [see comments]. J Nucl Med 1990;31:1899-905
  14. Stewart RE, Schwaiger M, Molina E, Popma J, Gacioch GM, Kalus M, et al. Comparison of rubidium-82 positron emission tomography and thallium-201 SPECT imaging for detection of coronary artery disease. Am J Cardiol 1991;67:1303-10 https://doi.org/10.1016/0002-9149(91)90456-U
  15. Choi JY, Lee KH, Kim YH, Lee EJ, Chung HW, Lee SJ, et al. Tl-201 redistribution SPECT and N-13 ammonia PET images in patients with old mocardial infarction and left ventricular dysfunction: segmental comparison and discordance analysis. Korean J Nucl Med 2004;38:218-224
  16. Di Carli M, Czernin J, Hoh CK, Gerbaudo VH, Brunken RC, Huang SC, et al. Relation among stenosis severity, myocardial blood flow, and flow reserve in patients with coronary artery disease. Circulation 1995;91:1944-51 https://doi.org/10.1161/01.CIR.91.7.1944
  17. Uren NG, Melin JA, De Bruyne B, Wijns W, Baudhuin T, Camici PG. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med 1994;330:1782-8 https://doi.org/10.1056/NEJM199406233302503
  18. Beanlands RS, Muzik O, Melon P, Sutor R, Sawada S, Muller D, et al. Noninvasive quantification of regional myocardial flow reserve in patients with coronary atherosclerosis using nitrogen-13 ammonia positron emission tomography. Determination of extent of altered vascular reactivity. J Am Coll Cardiol 1995;26:1465-75 https://doi.org/10.1016/0735-1097(95)00359-2
  19. Uren NG, Crake T, Lefroy DC, de Silva R, Davies GJ, Maseri A. Reduced coronary vasodilator function in infarcted and normal myocardium after myocardial infarction [see comments]. N Engl J Med 1994;331:222-7 https://doi.org/10.1056/NEJM199407283310402
  20. Yoshinaga K, Katoh C, Noriyasu K, Iwado Y, Furuyama H, Ito Y, et al. Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15-labeled water PET. J Nucl Cardiol 2003;10:275-83 https://doi.org/10.1016/S1071-3581(02)43243-6
  21. Parkash R, deKemp RA, Ruddy TD, Kitsikis A, Hart R, Beauschene L, et al. Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease. J Nucl Cardiol 2004;11:440-9 https://doi.org/10.1016/j.nuclcard.2004.04.005
  22. He ZX, Shi RF, Wu YJ, Tian YQ, Liu XJ, Wang SW, et al. Direct imaging of exercise-induced myocardial ischemia with fluorine-18-labeled deoxyglucose and Tc-99m-sestamibi in coronary artery disease. Circulation 2003;108:1208-13 https://doi.org/10.1161/01.CIR.0000088784.25089.D9
  23. Brown G, Albers JJ, Fisher LD, Schaefer SM, Lin JT, Kaplan C, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990;323:1289-98 https://doi.org/10.1056/NEJM199011083231901
  24. Kane JP, Malloy MJ, Ports TA, Phillips NR, Diehl JC, Havel RJ. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA 1990;264:3007-12 https://doi.org/10.1001/jama.264.23.3007
  25. Gould KL, Ornish D, Scherwitz L, Brown S, Edens RP, Hess MJ, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA 1995;274:894-901 https://doi.org/10.1001/jama.274.11.894
  26. Watts GF, Lewis B, Brunt JN, Lewis ES, Coltart DJ, Smith LD, et al. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas' Atherosclerosis Regression Study (STARS). Lancet 1992;339:563-9 https://doi.org/10.1016/0140-6736(92)90863-X
  27. Risk stratification and survival after myocardial infarction. N Engl J Med 1983;309:331-6 https://doi.org/10.1056/NEJM198308113090602
  28. Rahimtoola SH. The hibernating myocardium. Am Heart J 1989;117:211-21 https://doi.org/10.1016/0002-8703(89)90685-6
  29. Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 1982;66:1146-9 https://doi.org/10.1161/01.CIR.66.6.1146
  30. Di Carli MF, Prcevski P, Singh TP, Janisse J, Ager J, Muzik O, et al. Myocardial blood flow, function, and metabolism in repetitive stunning. J Nucl Med 2000;41:1227-34
  31. Nowak B, Sinha AM, Schaefer WM, Koch KC, Kaiser HJ, Hanrath P, et al. Cardiac resynchronization therapy homogenizes myocardial glucose metabolism and perfusion in dilated cardiomyopathy and left bundle branch block. J Am Coll Cardiol 2003;41:1523-8 https://doi.org/10.1016/S0735-1097(03)00257-2
  32. Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, et al. Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg 1998;116:997-1004 https://doi.org/10.1016/S0022-5223(98)70052-2
  33. Di Carli MF. Predicting improved function after myocardial revascularization. Curr Opin Cardiol 1998;13:415-24 https://doi.org/10.1097/00001573-199811000-00006
  34. Beanlands RS, Ruddy TD, deKemp RA, Iwanochko RM, Coates G, Freeman M, et al. Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function. J Am Coll Cardiol 2002;40:1735-43 https://doi.org/10.1016/S0735-1097(02)02489-0
  35. Di Carli MF, Asgarzadie F, Schelbert HR, Brunken RC, Laks H, Phelps ME, et al. Quantitative relation between myocardial viability and improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy. Circulation 1995;92:3436- 44 https://doi.org/10.1161/01.CIR.92.12.3436
  36. Marwick TH, Zuchowski C, Lauer MS, Secknus MA, Williams J, Lytle BW. Functional status and quality of life in patients with heart failure undergoing coronary bypass surgery after assessment of myocardial viability. J Am Coll Cardiol 1999;33:750-8 https://doi.org/10.1016/S0735-1097(98)00642-1
  37. Senior R, Kaul S, Raval U, Lahiri A. Impact of revascularization and myocardial viability determined by nitrate-enhanced Tc-99m sestamibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy. J Nucl Cardiol 2002;9:454-62 https://doi.org/10.1067/mnc.2002.123913
  38. Bax JJ, Poldermans D, Elhendy A, Cornel JH, Boersma E, Rambaldi R, et al. Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography. J Am Coll Cardiol 1999;34:163-9 https://doi.org/10.1016/S0735-1097(99)00157-6
  39. Rohatgi R, Epstein S, Henriquez J, Ababneh AA, Hickey KT, Pinsky D, et al. Utility of positron emission tomography in predicting cardiac events and survival in patients with coronary artery disease and severe left ventricular dysfunction. Am J Cardiol 2001;87:1096-9 https://doi.org/10.1016/S0002-9149(01)01468-0
  40. Allman K, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 2002;39:1151-8 https://doi.org/10.1016/S0735-1097(02)01726-6
  41. Udelson JE, Bonow RO, Dilsizian V. The historical and conceptual evolution of radionuclide assessment of myocardial viability. J Nucl Cardiol 2004;11:318-34 https://doi.org/10.1016/j.nuclcard.2004.03.030
  42. Mari C, Strauss WH. Detection and characterization of hibernating myocardium. Nucl Med Commun 2002;23:311-22 https://doi.org/10.1097/00006231-200204000-00004
  43. Fallavollita JA, Malm BJ, Canty JM Jr. Hibernating myocardium retains metabolic and contractile reserve despite regional reductions in flow, function, and oxygen consumption at rest. Circ Res 2003;92:48-55 https://doi.org/10.1161/01.RES.0000049104.57549.03
  44. Kim SJ, Peppas A, Hong SK, Yang G, Huang Y, Diaz G, et al. Persistent stunning induces myocardial hibernation and protection: flow/function and metabolic mechanisms. Circ Res 2003;92:1233-9 https://doi.org/10.1161/01.RES.0000076892.18394.B6
  45. Canty JM, Fallavollita JA. Hibernating myocardium. J Nucl Cardiol 2005;12:104-19 https://doi.org/10.1016/j.nuclcard.2004.11.003
  46. Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, et al. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol 2004;44:923-30 https://doi.org/10.1016/j.jacc.2004.06.042
  47. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003;228:826-33 https://doi.org/10.1148/radiol.2283021006
  48. Achenbach S, Moselewski F, Ropers D, Ferencik M, Hoffmann U, MacNeill B, et al. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segmentbased comparison with intravascular ultrasound. Circulation 2004;109:14-7 https://doi.org/10.1161/01.CIR.0000111517.69230.0F
  49. Rudd JH, Warburton EA, Fryer TD, Jones HA, Clark JC, Antoun N, et al. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 2002;105:2708-11 https://doi.org/10.1161/01.CIR.0000020548.60110.76
  50. Schoepf UJ, Becker CR, Ohnesorge BM, Yucel EK. CT of coronary artery disease. Radiology 2004;232:18-37 https://doi.org/10.1148/radiol.2321030636
  51. Achenbach S, Moshage W, Ropers D, Nossen J, Daniel WG. Value of electron-beam computed tomography for the noninvasive detection of high-grade coronary-artery stenoses and occlusions. N Engl J Med 1998;339:1964-71 https://doi.org/10.1056/NEJM199812313392702
  52. Achenbach S, Giesler T, Ropers D, Ulzheimer S, Derlien H, Schulte C, et al. Detection of coronary artery stenoses by contrastenhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomography. Circulation 2001;103:2535-8 https://doi.org/10.1161/01.CIR.103.21.2535
  53. Nieman K, Oudkerk M, Rensing BJ, van Ooijen P, Munne A, van Geuns RJ, et al. Coronary angiography with multi-slice computed tomography. Lancet 2001;357:599-603 https://doi.org/10.1016/S0140-6736(00)04058-7
  54. Becker CR, Knez A, Leber A, Treede H, Ohnesorge B, Schoepf UJ, et al. Detection of coronary artery stenoses with multislice helical CT angiography. J Comput Assist Tomogr 2002;26:750-755 https://doi.org/10.1097/00004728-200209000-00015
  55. Kopp AF, Schroeder S, Kuettner A, Baumbach A, Georg C, Kuzo R, et al. Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients. Eur Heart J 2002;23:1714-25
  56. Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, et al. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 2003;107:664-6 https://doi.org/10.1161/01.CIR.0000055738.31551.A9
  57. Di Carli MF. Advances in positron emission tomography. J Nucl Cardiol 2004;11:719-32 https://doi.org/10.1016/j.nuclcard.2004.09.007
  58. Marwick TH, Nemec JJ, Stewart WJ, Salcedo EE. Diagnosis of coronary artery disease using exercise echocardiography and positron emission tomography: comparison and analysis of discrepant results. J Am Soc Echocardiogr 1992;5:231-8
  59. Grover-McKay M, Ratib O, Schwaiger M, Wohlgelernter D, Araujo L, Nienaber C, et al. Detection of coronary artery disease with positron emission tomography and rubidium 82. Am Heart J 1992;123:646-52 https://doi.org/10.1016/0002-8703(92)90502-M
  60. Demer LL, Gould KL, Goldstein RA, Kirkeeide RL, Mullani NA, Smalling RW, et al. Assessment of coronary artery disease severity by positron emission tomography. Comparison with quantitative arteriography in 193 patients. Circulation 1989;79:825-35 https://doi.org/10.1161/01.CIR.79.4.825
  61. Tamaki N, Yonekura Y, Senda M, Yamashita K, Koide H, Saji H, et al. Value and limitation of stress thallium-201 single photon emission computed tomography: comparison with nitrogen-13 ammonia positron tomography. J Nucl Med 1988;29:1181-8
  62. Gould KL, Goldstein RA, Mullani NA, Kirkeeide RL, Wong WH, Tewson TJ, et al. Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. VIII. Clinical feasibility of positron cardiac imaging without a cyclotron using generator-produced rubidium-82. J Am Coll Cardiol 1986;7:775-89 https://doi.org/10.1016/S0735-1097(86)80336-9
  63. Eitzman D, al-Aouar Z, Kanter HL, vom Dahl J, Kirsh M, Deeb GM, et al. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography [see comments]. J Am Coll Cardiol 1992;20:559
  64. Di Carli MF, Davidson M, Little R, Khanna S, Mody FV, Brunken RC, et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol 1994;73: 527-33 https://doi.org/10.1016/0002-9149(94)90327-1
  65. Lee KS, Marwick TH, Cook SA, Go RT, Fix JS, James KB, et al. Prognosis of patients with left ventricular dysfunction, with and without viable myocardium after myocardial infarction. Relative efficacy of medical therapy and revascularization. Circulation 1994;90:2687-94 https://doi.org/10.1161/01.CIR.90.6.2687
  66. vom Dahl J, Altehoefer C, Sheehan FH, Buechin P, Schulz G, Schwarz ER, et al. Effect of myocardial viability assessed by technetium-99m-sestamibi SPECT and fluorine-18-FDG PET on clinical outcome in coronary artery disease. J Nucl Med 1997;38: 742-8