Quantitation of mitral regurgitation using positron emission tomography.

Background: Cardiac positron emission tomography (PET) offers non-invasive assessment of perfusion and left ventricular (LV) function from a single dynamic scan. However, no prior assessment of mitral regurgitation severity by PET has been presented. Application of indicator dilution techniques and gated image analyses to PET data enables calculation of forward stroke volume and total LV stroke volume.

Quantitative and qualitative comparison of Rubidium-82 and Oxygen-15 water cardiac PET.

Background: Differences in tracer characteristics may influence the interpretation of positron emission tomography myocardial perfusion imaging (MPI). We compare the reading of MPIs with a low-extraction retention tracer (Rb) and a high-extraction non-retention tracer (O-water) in a selected cohort of patients with known coronary artery disease (CAD).

Methods: Thirty-nine patients with known CAD referred to Rb MPI due to angina underwent rest and stress imaging with both tracers and experienced MPI readers provided blinded consensus reads of all studies.

Outcome prediction by myocardial external efficiency from C-acetate positron emission tomography in cardiac amyloidosis.

Aims: This study aimed to study the prognostic value of myocardial oxygen consumption (MVO ) and myocardial external efficiency (MEE) from C-acetate positron emission tomography (PET) in cardiac amyloidosis (CA) patients.

Methods And Results: Forty-eight CA patients, both transthyretin (ATTR) and immunoglobulin light chain (AL) amyloidosis, and 20 controls were included. All subjects were examined with C-acetate PET and echocardiography.

Detection and correction of patient motion in dynamic O-water PET MPI.

Background: Patient motion constitutes a limitation to O-water cardiac PET imaging. We examined the ability of image readers to detect and correct patient motion using simulated motion data and clinical patient scans.

Methods: Simulated data consisting of 16 motions applied to 10 motion-free scans were motion corrected using two approaches, pre-analysis and post-analysis for motion identification.

Association of Right Ventricular Myocardial Blood Flow With Pulmonary Pressures and Outcome in Cardiac Amyloidosis.

Background: Cardiac amyloidosis (CA) is a restrictive and infiltrative cardiomyopathy, characterized by increased biventricular filling pressures and low output. Symptoms are predominantly of right heart origin. The role of right ventricular (RV) myocardial blood flow (MBF) in CA has not been studied.

Myocardial External Efficiency in Asymptomatic Severe Primary Mitral Regurgitation Using C-Acetate PET.

Subjects with asymptomatic moderate-to-severe or severe primary mitral regurgitation are closely observed for signs of progression or symptoms requiring surgical intervention. The role of myocardial metabolic function in progression of mitral regurgitation is poorly understood. We used C-acetate PET to noninvasively measure myocardial mechanical external efficiency (MEE), which is the energetic ratio of external cardiac work and left ventricular (LV) oxygen consumption.

Left-ventricular volumes and ejection fraction from cardiac ECG-gated O-water positron emission tomography compared to cardiac magnetic resonance imaging using simultaneous hybrid PET/MR.

Background: O-water PET is the gold standard for noninvasive quantification of myocardial blood flow. In addition to evaluation of ischemia, the assessment of cardiac function and remodeling is important in all cardiac diseases. However, since O-water is freely diffusible and standard uptake images show little contrast between the myocardium and blood pool, the assessment of left-ventricular (LV) volumes and ejection fraction (EF) is challenging.

Influence of image reconstruction on quantitative cardiac O-water positron emission tomography.

Background: The impact on quantitative O-water PET/CT of a wide range of different reconstruction settings, including regularized reconstruction by block-sequential regularized expectation maximization (BSREM), was investigated.

Methods: Twenty clinical stress scans from patients referred for assessment of myocardial ischemia were included. Patients underwent a 4-min dynamic stress PET scan with O-water on a digital PET/CT scanner.

Quantitative myocardial perfusion response to adenosine and regadenoson in patients with suspected coronary artery disease.

Background: The aim of the present study was to compare the quantitative flow responses of regadenoson against adenosine using cardiac O-water PET imaging in patients with suspected or known coronary artery disease (CAD).

Methods: Hyperemic myocardial blood flow (MBF) after adenosine and regadenoson was compared using correlation and Bland-Altman analysis in 21 patients who underwent rest and adenosine O-water PET scans followed by rest and regadenoson O-water PET scans.

Results: Global mean (± SD) MBF values at rest and stress were 0.

Diagnosis of left ventricular hypertrophy using non-ECG-gated O-water PET.

Aim: To develop a method for diagnosing left ventricular (LV) hypertrophy from cardiac perfusion O-water positron emission tomography (PET).

Methods: We retrospectively pooled data from 139 subjects in four research cohorts. LV remodeling patterns ranged from normal to severe eccentric and concentric hypertrophy.

Influence of patient motion on quantitative accuracy in cardiac O-water positron emission tomography.

Background: Patient motion is a common problem during cardiac PET. The purpose of the present study was to investigate to what extent motions influence the quantitative accuracy of cardiac O-water PET/CT and to develop a method for automated motion detection.

Method: Frequency and magnitude of motion was assessed visually using data from 50 clinical O-water PET/CT scans.

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation- (4Is) related cardiovascular diseases: a joint collaboration of the EACVI and the EANM: summary.

With this summarized document we share the standard for positron emission tomography (PET)/(diagnostic)computed tomography (CT) imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is) as recently published in the European Journal of Nuclear Medicine and Molecular Imaging. This standard should be applied in clinical practice and integrated in clinical (multicentre) trials for optimal standardization of the procedurals and interpretations. A major focus is put on procedures using [18F]-2-fluoro-2-deoxyglucose ([18F]FDG), but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this summarized document.

Effect of PET-CT misalignment on the quantitative accuracy of cardiac O-water PET.

Background: Quantification of myocardial blood flow (MBF) with PET requires accurate attenuation correction, which is performed using a separate CT. Misalignment between PET and CT scans has been reported to be a common problem. The purpose of the present study was to assess the effect of PET CT misalignment on the quantitative accuracy of cardiac O-water PET.

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM.

With this document, we provide a standard for PET/(diagnostic) CT imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is). This standard should be applied in clinical practice and integrated in clinical (multicenter) trials for optimal procedural standardization. A major focus is put on procedures using [F]FDG, but 4Is PET radiopharmaceuticals beyond [F]FDG are also described in this document.

Renography with a semiautomated algorithm for diuretic decision 7 min postradiopharmaceutical administration: a feasibility study.

Objective: The F+10 method for diuretic renography (diuretics given 10 min after the radiopharmaceutical) could be a time-conserving method. This method involves a 30-min dynamic acquisition where diuretics are administered only when necessary by the Nuclear Medicine technologist performing the examination. The purpose of this study was to assess the method's performance and to discover the optimal threshold of residual activity for a diuretic administration 7 min into the F+10 renography by reprocessing raw data from prior performed examinations with 20-min acquisitions without diuretics.

Diagnostic Accuracy of [C]PIB Positron Emission Tomography for Detection of Cardiac Amyloidosis.

Objectives: This dual-site study evaluated the diagnostic accuracy of the method.

Background: Pittsburgh compound ([C]PIB) positron emission tomography (PIB-PET) has shown promise as a specific and noninvasive method for the diagnosis of cardiac amyloidosis (CA).

Methods: The study had 2 parts.

Evaluation of quantitative CMR perfusion imaging by comparison with simultaneous O-water-PET.

Background: We assessed the quantitative accuracy of cardiac perfusion measurements using dynamic contrast-enhanced MRI with simultaneous O-water PET as reference with a fully integrated PET-MR scanner.

Methods: 15 patients underwent simultaneous DCE MRI and O-water PET scans at rest and adenosine-stress on an integrated PET-MR scanner. Correlation and agreement between MRI- and PET-based global and regional MBF values were assessed using correlation and Bland-Altman analysis.

Quantification of C-PIB kinetics in cardiac amyloidosis.

Background: The purpose of this work was to determine the optimal tracer kinetic model of C-PIB and to validate the use of the simplified methods retention index (RI) and standardized uptake value (SUV) for quantification of cardiac C-PIB uptake in amyloidosis.

Methods And Results: Single-tissue, reversible and irreversible two-tissue models were fitted to data from seven cardiac amyloidosis patients who underwent C-PIB PET scans and arterial blood sampling for measurement of blood radioactivity and metabolites. The irreversible two-tissue model (2Tirr) best described cardiac C-PIB uptake.

Automatic calculation of myocardial external efficiency using a single C-acetate PET scan.

Background: Myocardial external efficiency (MEE) is defined as the ratio of kinetic energy associated with cardiac work [forward cardiac output (FCO)*mean systemic pressure] and the chemical energy from oxygen consumed (MVO) by the left ventricular mass (LVM). We developed a fully automated method for estimating MEE based on a single C-acetate PET scan without ECG-gating.

Methods And Results: Ten healthy controls, 34 patients with aortic valve stenosis (AVS), and 20 patients with mitral valve regurgitation (MVR) were recruited in a dual-center study.

Calculation of left ventricular volumes and ejection fraction from dynamic cardiac-gated O-water PET/CT: 5D-PET.

Background: Quantitative measurement of myocardial blood flow (MBF) is of increasing interest in the clinical assessment of patients with suspected coronary artery disease (CAD). O-water positron emission tomography (PET) is considered the gold standard for non-invasive MBF measurements. However, calculation of left ventricular (LV) volumes and ejection fraction (EF) is not possible from standard O-water uptake images.

Automatic extraction of forward stroke volume using dynamic PET/CT: a dual-tracer and dual-scanner validation in patients with heart valve disease.

Background: The aim of this study was to develop and validate an automated method for extracting forward stroke volume (FSV) using indicator dilution theory directly from dynamic positron emission tomography (PET) studies for two different tracers and scanners.

Methods: 35 subjects underwent a dynamic (11)C-acetate PET scan on a Siemens Biograph TruePoint-64 PET/CT (scanner I). In addition, 10 subjects underwent both dynamic (15)O-water PET and (11)C-acetate PET scans on a GE Discovery-ST PET/CT (scanner II).

Accurate analysis and visualization of cardiac (11)C-PIB uptake in amyloidosis with semiautomatic software.

Background: (11)C-PIB PET is a promising non-invasive diagnostic tool for cardiac amyloidosis. Semiautomatic analysis of PET data is now available but it is not known how accurate these methods are for amyloid imaging. The aim of this study was to evaluate the feasibility of one semiautomatic software tool for analysis and visualization of (11)C-PIB left ventricular retention index (RI) in cardiac amyloidosis.

Effect of Gender on Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarction Without Obstructive Coronary Artery Disease.

The aim of this study was to compare the prognoses of patients with ST-segment elevation myocardial infarction (STEMI) and those with non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) and the risk associated with gender for future cardiovascular events. The study population was selected from 95,849 patients who underwent coronary angiography for myocardial infarction from 2005 to 2010 and registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Outcome analyses, including all-cause death, myocardial infarction, congestive heart failure, stroke, and revascularization, were performed in 2,268 patients with STEMI and 10,904 with NSTEMI without obstructive CAD (<50% stenosis).