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

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

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).

Conclusions

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.

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Abbreviations

CT:

Computed tomography

PET:

Positron emission tomography

STEMI:

ST-elevation myocardial infarction

IRA:

Infarct-related artery

TBR:

Tissue-to-background ratio

LGE:

Late gadolinium enhancement (imaging)

18F-NaF:

Sodium fluoride tracer

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Disclosures

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.

Author information

Author notes

  1. A. Therese Sjöholm MSc

    Present address: Department of Radiology, Uppsala University, Uppsala, Sweden

Authors and Affiliations

  1. Clinical Imaging Research Centre, A*STAR-NUS, Singapore, Singapore

    Stephanie Marchesseau MSc, PhD, A. Therese Sjöholm MSc, Jamie X. M. Ho MMagResonTech, David W. Townsend PhD & John J. Totman DCR, MSc, PhD

  2. Department of Cardiology, National University Heart Centre, Singapore, Singapore

    Aruni Seneviratna MBBS, Daphne Liang Qin DipNurs & Mark Y. Y. Chan MBBS, MHS, MMED, MRCP

  3. The Hatter Cardiovascular Institute, University College London, London, UK

    Derek J. Hausenloy MBChB, PhD, FRCP, FACC, FESC

  4. The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK

    Derek J. Hausenloy MBChB, PhD, FRCP, FACC, FESC

  5. National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore

    Derek J. Hausenloy MBChB, PhD, FRCP, FACC, FESC

  6. Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore

    Derek J. Hausenloy MBChB, PhD, FRCP, FACC, FESC

  7. Cardiovascular Research Institute, NUHS, Singapore, Singapore

    A. Mark Richards MBChB, MD, PhD, DSc, FRACP, FRCP, FRSNZ

Authors
  1. Stephanie Marchesseau MSc, PhD
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  2. Aruni Seneviratna MBBS
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Corresponding author

Correspondence to Stephanie Marchesseau MSc, PhD.

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Funding

This work has been partially funded by the NMRC NUHS Centre Grant—Medical Image Analysis Core (NMRC/CG/013/2013).

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Marchesseau, S., Seneviratna, A., Sjöholm, A.T. et al. Hybrid PET/CT and PET/MRI imaging of vulnerable coronary plaque and myocardial scar tissue in acute myocardial infarction. J. Nucl. Cardiol. 25, 2001–2011 (2018). https://doi.org/10.1007/s12350-017-0918-8

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  • DOI: https://doi.org/10.1007/s12350-017-0918-8

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