Downstream indication to revascularization following hybrid cardiac PET/MRI: preliminary results

BACKGROUNDHybrid PET/MRI allows the acquisition of both fluorine-18-fluorodeoxyglucose (F-FDG) PET and cardiac magnetic resonance (CMR) during one session. Whether this will result in different referral to coronary revascularization (CR) is unknown. We compared this new hybrid method with all-nuclea...

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Published in:	Nuclear medicine communications Vol. 38; no. 6; pp. 515 - 522
Main Authors:	Priamo, Julien, Adamopoulos, Dionysos, Rager, Oliver, Frei, Angela, Noble, Stephane, Carballo, David, Ratib, Osman, Nkoulou, René
Format:	Journal Article
Language:	English
Published:	England Copyright Wolters Kluwer Health, Inc. All rights reserved 01-06-2017
Subjects:	Adult Aged Aged, 80 and over Female Fluorodeoxyglucose F18 Heart - diagnostic imaging Humans Magnetic Resonance Imaging Male Middle Aged Multimodal Imaging Myocardial Perfusion Imaging Myocardial Revascularization Positron-Emission Tomography Tissue Survival
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Summary:	BACKGROUNDHybrid PET/MRI allows the acquisition of both fluorine-18-fluorodeoxyglucose (F-FDG) PET and cardiac magnetic resonance (CMR) during one session. Whether this will result in different referral to coronary revascularization (CR) is unknown. We compared this new hybrid method with all-nuclear/all-CMR methods in the assessment of viable myocardium and in downstream referral to CR. PATIENTS AND METHODSOverall, 12 patients with rest perfusion defects on a single photon emission computed tomography (SPECT) were recruited for cardiac viability assessment using a PET/MRI device. Perfusion (SPECT and CMR), metabolism, late gadolinium enhancement (LGE), and contractility were compared using a 20-segments bull’s eye for agreement. The patterns of ischemia/viability were compared between all-nuclear, all-CMR, and hybrid methods. Downstream CR was proposed after correlating findings to coronary angiography. RESULTSThe SPECT and CMR perfusion denoted poor agreement [agreement rate (AR)60%; κ0.191, P<0.004]. The added PET metabolism concurred in reclassifying 19.2% of segments with intermediate or unassessable LGE using the hybrid method. Overall, the all-CMR method showed better agreement with the hybrid method than the all-nuclear method for findings of normal (AR100%, κ1.00 vs. 65.8% %; κ0.347, respectively; P<0.001), scar (AR85%; κ0.675 vs. 80.8%; κ0.596, respectively; P<0.001), and ischemic segments (AR95.8%; κ0.881 vs. 75.8%; κ0.168, respectively; P<0.001). Downstream CR was proposed in four, 11, and 12 vessels by the all-nuclear, all-CMR, or hybrid methods, respectively. CONCLUSIONCompared with all-CMR, the hybrid method allowed the reclassification of 19.2% segments. Using CMR perfusion instead of SPECT perfusion had a significant impact on downstream target vessel revascularization.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0143-3636 1473-5628
DOI:	10.1097/MNM.0000000000000680