Journal of Nuclear Cardiology

, Volume 25, Issue 6, pp 2001–2011 | Cite as

Hybrid PET/CT and PET/MRI imaging of vulnerable coronary plaque and myocardial scar tissue in acute myocardial infarction

  • Stephanie MarchesseauEmail author
  • Aruni Seneviratna
  • A. Therese Sjöholm
  • Daphne Liang Qin
  • Jamie X. M. Ho
  • Derek J. Hausenloy
  • David W. Townsend
  • A. Mark Richards
  • John J. Totman
  • Mark Y. Y. Chan
Original Article



Following an acute coronary syndrome, combined CT and PET with 18F-NaF can identify coronary atherosclerotic plaques that have ruptured or eroded. However, the processes behind 18F-NaF uptake in vulnerable plaques remain unclear.

Methods and Results

Ten patients with STEMI were scanned after 18F-NaF injection, for 75 minutes in a Siemens PET/MR scanner using delayed enhancement (LGE). They were then scanned in a Siemens PET/CT scanner for 10 minutes. Tissue-to-background ratio (TBR) was compared between the culprit lesion in the IRA and remote non-culprit lesions in an effort to independently validate prior studies. Additionally, we performed a proof-of-principle study comparing TBR in scar tissue and remote myocardium using LGE images and PET/MR or PET/CT data. From the 33 coronary lesions detected on PET/CT, TBRs for culprit lesions were higher than for non-culprit lesions (TBR = 2.11 ± 0.45 vs 1.46 ± 0.48; P < 0.001). Interestingly, the TBR measured on the PET/CT was higher for infarcted myocardium than for remote myocardium (TBR = 0.81 ± 0.10 vs 0.71 ± 0.05; P = 0.003). These results were confirmed using the PET/MR data (TBR = 0.81 ± 0.10 for scar, TBR = 0.71 ± 0.06 for healthy myocardium, P = 0.03).


We confirmed the potential of 18F-NaF PET/CT imaging to detect vulnerable coronary lesions. Moreover, we demonstrated proof-of-principle that 18F-NaF concurrently detects myocardial scar tissue.


PET imaging Infarction Myocardial Magnetic resonance imaging Vulnerable atherosclerotic plaque 



Computed tomography


Positron emission tomography


ST-elevation myocardial infarction


Infarct-related artery


Tissue-to-background ratio


Late gadolinium enhancement (imaging)


Sodium fluoride tracer



Stephanie Marchesseau, Aruni Seneviratna, A. Therese Sjoholm, Daphne Liang Qin, Jamie X.M. Ho, Derek J. Hausenloy, David W. Townsend, A. Mark Richards, John J. Totman, and Mark Y.Y. Chan declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

12350_2017_918_MOESM1_ESM.pptx (240 kb)
Supplementary material 1 (PPTX 239 kb)


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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Stephanie Marchesseau
    • 1
    Email author
  • Aruni Seneviratna
    • 2
  • A. Therese Sjöholm
    • 1
    • 8
  • Daphne Liang Qin
    • 2
  • Jamie X. M. Ho
    • 1
  • Derek J. Hausenloy
    • 3
    • 4
    • 5
    • 6
  • David W. Townsend
    • 1
  • A. Mark Richards
    • 7
  • John J. Totman
    • 1
  • Mark Y. Y. Chan
    • 2
  1. 1.Clinical Imaging Research CentreA*STAR-NUSSingaporeSingapore
  2. 2.Department of CardiologyNational University Heart CentreSingaporeSingapore
  3. 3.The Hatter Cardiovascular InstituteUniversity College LondonLondonUK
  4. 4.The National Institute of Health Research University College London Hospitals Biomedical Research CentreLondonUK
  5. 5.National Heart Research Institute SingaporeNational Heart Centre SingaporeSingaporeSingapore
  6. 6.Cardiovascular and Metabolic Disorders ProgramDuke-National University of Singapore Medical SchoolSingaporeSingapore
  7. 7.Cardiovascular Research InstituteNUHSSingaporeSingapore
  8. 8.Department of RadiologyUppsala UniversityUppsalaSweden

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