• Title/Summary/Keyword: Cardiac PET

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PET and PET/CT in Clinical Cardiology (심장 PET과 PET/CT의 임상적 이용)

  • Won, Kyoung-Sook
    • The Korean Journal of Nuclear Medicine
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    • v.39 no.2
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    • pp.124-132
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    • 2005
  • 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.

Radiopharmaceuticals Used in Cardiac Imaging (심장영상에 이용되는 방사성의약품)

  • Hwang, Kyung-Hoon;Chung, Yong-An;Lee, Byeong-Il;Lee, Yu-Kyung;Lee, Min-Kyung;Choe, Won-Sick
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.3
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    • pp.174-178
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    • 2009
  • Many radiopharmaceuticals have been developed and wildy used in the imaging cardiac function. Myocardial perfusion imaging (MPI) is a well established noninvasive method of assessing coronary blood flow and has been widely used in patients diagnosed or suspected with coronary artery diseases. The innovation of radiopharmaceuticals used in the cardiac imaging is one of the most important contributors to the development of nuclear cardiology. Thallium-201 and various technetium-99m agents have been globally used for myocardial perfusion SPEG, and N-13 ammonia (13NH3), rubidium-82 (82Rb), 0-15 water (H2150) for myocardial perfusion PET. As well as the cardiac perfusion studies, new radiopharmaceuticals that visualize fat metabolism or receptors of the sympathetic nervous system have successfully been applied to clinical practice. Useful information can be obtained for diagnosing coronary artery disease, evaluating patients' condition, or assessing therapeutic effects. In this review, we describe the characteristics and clinical usefulness of radiopharmaceuticals used for cardiac SPEG and PET.

Recent Update of Advanced Imaging for Diagnosis of Cardiac Sarcoidosis: Based on the Findings of Cardiac Magnetic Resonance Imaging and Positron Emission Tomography

  • Chang, Suyon;Lee, Won Woo;Chun, Eun Ju
    • Investigative Magnetic Resonance Imaging
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    • v.23 no.2
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    • pp.100-113
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    • 2019
  • Sarcoidosis is a multisystem disease characterized by noncaseating granulomas. Cardiac involvement is known to have poor prognosis because it can manifest as a serious condition such as the conduction abnormality, heart failure, ventricular arrhythmia, or sudden cardiac death. Although early diagnosis and early treatment is critical to improve patient prognosis, the diagnosis of CS is challenging in most cases. Diagnosis usually relies on endomyocardial biopsy (EMB), but its diagnostic yield is low due to the incidence of patchy myocardial involvement. Guidelines for the diagnosis of CS recommend a combination of clinical, electrocardiographic, and imaging findings from various modalities, if EMB cannot confirm the diagnosis. Especially, the role of advanced imaging such as cardiac magnetic resonance (CMR) imaging and positron emission tomography (PET), has shown to be important not only for the diagnosis, but also for monitoring treatment response and prognostication. CMR can evaluate cardiac function and fibrotic scar with good specificity. Late gadolinium enhancement (LGE) in CMR shows a distinctive enhancement pattern for each disease, which may be useful for differential diagnosis of CS from other similar diseases. Effectively, T1 or T2 mapping techniques can be also used for early recognition of CS. In the meantime, PET can detect and quantify metabolic activity and can be used to monitor treatment response. Recently, the use of a hybrid CMR-PET has introduced to allow identify patients with active CS with excellent co-localization and better diagnostic accuracy than CMR or PET alone. However, CS may show various findings with a wide spectrum, therefore, radiologists should consider the possible differential diagnosis of CS including myocarditis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy, amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. Radiologists should recognize the differences in various diseases that show the characteristics of mimicking CS, and try to get an accurate diagnosis of CS.

Quantitative Analysis of Dynamic PET images in Cardiac patients using Patlak tool on GE PET workstation

  • Son, Hye-Kyung;Mijin Yun;Kim, Dong-Hyeon;Haijo Jung;Lee, Jong-Doo;Yoo, Hyung-Sik;Kim, Hee-Joung
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2002.09a
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    • pp.314-317
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    • 2002
  • The purpose of this study was to evaluate the clinical application of Patlak tool on GE PET workstation for quantitative analysis of dynamic PET images in cardiac patients. Three patients including coronary artery disease (CAD), myocardial infarction (MI), and angina were studied. All subjects underwent dynamic cardiac PET scan using a GE Advance scanner. After 10 min transmission scan for attenuation correction using two rotating $\^$68/Ge rod sources, three patients with cardiac disease were performed dynamic cardiac PET scan after the administration of approximately 370 MBq of FDG. The dynamic scan consisted of 36 frames with variable frame length (12${\times}$10s, 6${\times}$20s, 6${\times}$60s, 12${\times}$300s) for a total time of 70 min. Blood samples were obtained to determine the plasma substrate concentration. Region of interest of circular and rectangular shape to acquire input functions and tissue data were placed on left ventricle and myocardium. A value of 0.67 was used for lumped constant. Mean plasma substrate concentrations for three patients were 100 mg/dl (CAD), 100 mg/dl (MI), 132 mg/dl (angina), respectively. Regional MMRGlc values (mean${\pm}$SD) at lateral myocardium area for CAD, MI, and angina were 8.43${\pm}$0.24, 4.08${\pm}$0.16, and 6.15${\pm}$0.23 mg/min/100ml, respectively. Patlak tool on GE PET workstation appeared to be useful for quantitative analysis of dynamic PET images in cardiac patients, although further studies may be required for absolute quantitation.

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Evaluation of Myocardial Blood Flow and Coronary Flow Reserve Using Positron Emission Tomography (양전자방출단층촬영을 이용한 심근혈류 및 관상동맥 혈류예비능 평가)

  • Lee, Byeong-Il;Bom, Hee-Seung
    • The Korean Journal of Nuclear Medicine
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    • v.39 no.2
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    • pp.118-123
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    • 2005
  • Positron emission tomography (PET) serves as a gold standard for noninvasive in vivo measurement of myocardial blood flow (MBF) and coronary flow reserve (CFR). CFR can be defined as the ratio of maximally vasodilated MBF over its basal flow. It is an important parameter for the evaluation of functional severity of coronary stenosis and prognositification in various diseases such as dilated cardiomyopathy. $^{13}NH_3,\;H_2^{15}O,\;^{82}Rb$ are widely used radiopharmaceuticals for measuring MBF and CFR, This review introduces imaging techniques and its clinical utility. Cardiac application or PET and PET/CT is expected to be increased in near future.

Clinical Application of Cardiac Hybrid Imaging in Coronary Artery Disease (관상동맥질환에서 심장 하이브리드 영상의 임상적 이용)

  • Gho, Ihn-Ho;Kong, Eun-Jung
    • Journal of Yeungnam Medical Science
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    • v.26 no.1
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    • pp.15-23
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    • 2009
  • Constant technological developments in coronary artery disease have contributed to the assessment of both the presence of coronary stenosis and its hemodynamic consequences. Hence, noninvasive imaging helps guide therapeutic decisions by providing complementary information on coronary morphology and on myocardial perfusion and metabolism. This can he done using single photon emission computed tomography (SPECT) or positron emission tomography (PET) and multidetector CT (MDCT). Advances in image-processing software and the advent of SPECT/CT and PET/CT have paved the way for the combination of image datasets from different modalities, giving rise to hybrid imaging. Three dimensional cardiac hybrid imaging helped to confirm hemodynamic significance in many lesions, add new lesions such as left main coronay artery disease, exclude equivocal defects, correct the corresponding arteries to their allocated defects and identify culprit segment. Cardiac hybrid imaging avoids the mental integration of functional and morphologic images and facilitates a comprehensive interpretation of coronaty lesions and their pathophysiologic adequacy by three dimensional display of fused images, and allows the best evaluation of myocardial territories and the coronary-artery branches that serve each territory. This integration of functional and morphological information were feasible to intuitively convincing and might facilitate development of a comprehensive non-invasive assessment of coronary artery disease.

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State of the Art of Imaging Equipment and Tools for Nuclear Cardiology (심장핵의학 검사를 위한 영상장비 및 도구의 최신동향)

  • Lee, Byeong-Il
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.3
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    • pp.165-173
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    • 2009
  • Nuclear cardiology in Korea is less active, compared to nuclear oncology, but it has been specialized and ramified. Lately, sophisticated nuclear cardiac imaging methods provide more convenience for patients. It is necessary to accurately estimate the recent progress in the imaging devices for nuclear cardiology. Myocardial perfusion imaging is a well established study to evaluate heart function. Myocardial perfusion SPECT and PET have been used for assessment of coronary artery disease with various radiopharmaceuticals. And of late, the development of advanced imaging devices - multi-pinhole technique and high definition imaging technique - and software made the scanning time shorter and expanded the application field. Therefore, it is required to review the nuclear cardiology hardware/software for the clinical practice and research. In this review, the characteristics about recently-developed SPECT/PET and software for nuclear cardiology are described. It is hoped that this information would contribute to improving the activity of nuclear cardiac research in Korea where the research for the fusion imaging combining a and nuclear imaging is drawing more attention.

Myocardial Perfusion PET (심근관류 PET)

  • Cho, Ihn-Ho;Kong, Eun-Jung
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.3
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    • pp.207-214
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    • 2009
  • Positron emission tomogrpahy (PET) represents the most advanced scintigraphic imaging technology. With the increase in availability of PET, the clinical use of PET has grown in medical fields. This can be employed for cardiovascular research as well as for clinical applications in patients with various cardiovascular disease. PET allows non-invasive functional assessment of myocardial perfusion, substrate metabolism and cardiac innervation and receptors as well as gene expression in vivo. PET is regarded as the gold standard for the detection of myocardial viability, and it is the only method available for the quantitative assessment of myocardial blood flow. This review focuses on the clinical applications of myocardial perfusion PET in coronary artery disease.

Current Status and Future Perspective of PET (PET 이용 현황 및 전망)

  • Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.1
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    • pp.1-7
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    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.

Synthesis of [18F]-Labelled Nebivolol as a β1-Adrenergic Receptor Antagonist for PET Imaging Agent (베타1-아드레날린 수용체를 표적으로 하는 심근영상제로서 18F 표지된 nebivolol의 합성)

  • Kim, Taek-Soo;Park, Jeong Hoon;Lee, Jun Young;Yang, Seung Dae;Chang, Dong-Jo
    • Journal of Radiation Industry
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    • v.10 no.4
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    • pp.181-187
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    • 2016
  • Selective ${\beta}_1$-agonist and antagonists are used for the treatment of cardiac diseases including congestive heart failure, angina pectoris and arrhythmia. Selective ${\beta}_1$-antagonists including nebivolol have high binding affinity on ${\beta}_1$-adrenergic receptor, not ${\beta}_2$-receptor mainly expressed in smooth muscle. Nebivolol is one of most selective ${\beta}_1$-blockers in clinically used ${\beta}_1$-blockers including atenolol and bisoprolol. We tried to develop clinically useful cardiac PET tracers using a selective ${\beta}_1$-blocker. Nebivolol is $C_2$-symmetric and has two chromane moiety with a secondary amino alcohol and aromatic fluorine. We adopted the general synthetic strategy using epoxide ring opening reaction. Unlike formal synthesis of nebivolol, we prepared two chromane building blocks with fluorine and iodine which was transformed to diaryliodonium salt for labelling of $^{18}F$. Two epoxide building blocks were readily prepared from commercially available chromene carboxylic acids (1, 8). Then, the amino alcohol building block (15) was prepared by ammonolysis of epoxide (14) followed by coupling reaction with the other building block, epoxide (7). Diaryliodonium salt, a precursor for $^{18}F$-aromatic substitution, was synthesized in moderate yield which was readily subjected to $^{18}F$-aromatic substitution to give $^{18}F$-labelled nebivolol.