This book is a clinically oriented, up-to-date, and in-depth review of the various applications of FDG-PET/CT and PET/MR in cardiovascular diseases with emphasis on the current available evidence. Positron emission tomography (PET) imaging with fluorodeoxyglucose (FDG) has seen increased applications in cardiovascular diseases over the last decades. Its utility is already established in a wide range of conditions, including myocardial viability imaging, assessment of inflammatory diseases such as sarcoidosis and vasculitis, as well as imaging of infectious processes, such as infective endocarditis and cardiac implantable electronic device infection. In addition, there are several emerging indications such as the imaging of left ventricular assisting device infection and native valve endocarditis as well as new applications under investigation.
The first section of the book reviews the technical basis of cardiovascular PET/CT and PET/MR imaging as well as cardiac metabolism. The following chapters each present specific pathologies, presenting epidemiology, pathophysiology, and diagnostic strategies, along with high quality clinical cases to support the discussion. The final chapter is a review of 15 interesting and clinically relevant cases.
This is an ideal guide for nuclear medicine physicians, cardiologists, radiologists, residents, post-graduate fellows, and technologists.
Author(s): Matthieu Pelletier-Galarneau, Patrick Martineau
Publisher: Springer
Year: 2022
Language: English
Pages: 381
City: Cham
Preface
Contents
Part I: Instrumentation and Metabolism
1: Cardiac Positron Emission Tomography Basics
Introduction
Basic Radiation Physics in PET Imaging
Radioactive Decay by Positron Emission and Electron Capture
The Positron Annihilation Process
Important Isotopes Used in PET Imaging
Radiation Detection and PET Detector Systems
Scintillation Detectors
Photomultiplier Tubes (PMTs)
The PET Camera
Data Acquisition, Projections, and Sinograms
Correction for Physical Effects and Image Reconstruction
Correction for Scatter Coincident Events
Correction for Random Coincident Events
Correction for Cascade Gamma Coincident Events
Correction for Detector Dead Time and Pulse Pile-Up
Correction for Photon Attenuation
Intrinsic and Reconstructed Spatial Resolution
Image Reconstruction from Projections
Filtered Back-Projection
Iterative Reconstruction
References
2: Cardiac PET/MR Basics
Introduction
PET/MR Instrumentation
Attenuation Correction
Motion Correction
Radiation Dose Reduction
Cardiac MRI
References
3: Review of Cardiac Metabolism and FDG
Introduction
Cardiac Metabolism in Health
The Basics of Cardiac Metabolism: Free Fatty Acids, Glucose, Ketones
FFA Metabolism in Myocardium
Glucose Metabolism in Myocardium
Ketone Metabolism in Myocardium
Cardiac Metabolism in Disease
Cardiac Metabolism and Aging
Cardiac Metabolism and Heart Failure
Cardiac Metabolism in Obesity and Diabetes
Cardiac Metabolism in Ischemia
Conclusion
References
4: Myocardial Suppression Protocols
Introduction
Underlying Physiology of Myocardial and Inflammatory Cell Glucose Metabolism
Goals of Preparation for 18F-FDG-PET Imaging
Patterns of Myocardial 18F-FDG Uptake
Approaches to Suppress Myocardial 18F-FDG Uptake
Dietary Strategies
Prolonged Fasting
High-Fat Low-Carbohydrate Diet
High-Fat Drink
Behavioral Strategies
Pharmacologic Strategies
Heparin
Calcium Channel Blockers
Communication
Combination Strategies
Laboratory Values
Patient Populations Requiring Special Considerations
Current Recommendations
Future Directions
References
Part II: Inflammatory and Malignant Disorders
5: Cardiac Sarcoidosis
Introduction
Histopathology
Epidemiology
Rates of Cardiac Involvement
Clinical Presentation and Prognosis
Diagnostic Workup
Serum Biomarkers
Endomyocardial Biopsy
ECG Findings
Echocardiography
Cardiac Magnetic Resonance (CMR)
FDG-PET Imaging of Patients with CS
Protocols for Cardiac FDG-PET Imaging
Interpretation Criteria
Diagnostic Accuracy of FDG-PET for the Assessment of CS
Prognostic Significance
Role in Assessing Response
FDG-PET/MR for the Assessment of CS
Comparison of FDG-PET/CT to MRI
Future Directions
Conclusion
References
6: Myocarditis
Introduction
Epidemiology
Clinical Presentation
Myocarditis Classification
Lymphocytic Viral Myocarditis
Giant Cell Myocarditis
Cardiac Sarcoidosis
Eosinophilic Cardiomyopathy
Diagnosis and Investigation
Endomyocardial Biopsy
Echocardiography
Cardiac Magnetic Resonance (CMR)
Lake Louise Criteria
Positron Emission Tomography
PET/MR
Imaging Protocol and Interpretation
Conclusion
References
7: Large Vessel Vasculitis
Introduction
FDG-PET Procedure
Patient Preparation
PET Acquisition Procedure
Interpretation and Reporting of FDG-PET/CT
Visual Grading Scales
Cranial Artery Assessment
Quantification
Diagnostic Performance
Monitoring and Follow-Up
PET Combined with CTA or MRA
Potential Pitfalls in LVV FDG-PET Imaging
Perspectives in LVV Imaging
References
8: Pericardial Diseases
Introduction
Infectious Pericardial Diseases
Autoimmune Pericardial Diseases
Neoplastic Pericardial Diseases
Other Non-Infectious Pericardial Diseases
Conclusion
References
9: Ventricular Arrhythmias
Introduction
Mechanistic Bases
General Principles of 18F-FDG PET/CT Imaging in the Setting of Ventricular Arrhythmias
Cardiac Sarcoidosis
Ventricular Arrhythmias of Unknown Etiology
Conclusion
References
10: Cardiac Tumors
Introduction
Primary Cardiac and Pericardiac Lesions
Epidemiology of Primary Cardiac Lesions
Types of Primary Cardiac and Pericardiac Masses
Symptoms and Clinical Presentation
Diagnostic Approach
Benign Cardiac Lesions
Intra-Cardiac Thrombi
Vegetations
Calcified Amorphous Tumors
Cardiac Myxoma
Papillary Fibroelastoma
Lipoma
Rhabdomyoma
Fibroma
Hemangioma
Tumors of Uncertain Biological Behavior
Cardiac Paraganglioma
Germ Cell Tumors
Malignant Cardiac Lesions
Cardiac Angiosarcoma
Leiomyosarcoma
Rhabdomyosarcoma
Primary Cardiac Lymphoma
Secondary Cardiac Masses
Epidemiology of Secondary Cardiac Lesions
Sources of Secondary Cardiac Masses
Secondary Cardiac Lymphoma
Miscellaneous Cardiac Lesions
Lipomatous Hypertrophy of the Interatrial Septum
Mechanisms of Spread to the Heart and Pericardium
Cardiac Lymphatic Anatomy
Roles of FDG-PET Imaging of Cardiac Masses
Cardiac Metabolism and Patient Preparation for Cardiac FDG-PET
FDG-PET/CT
FDG-PET/MRI
Conclusion
References
11: Fibrosing Mediastinitis
Fibrosing Mediastinitis
References
Part III: Cardiovascular Infections
12: Prosthetic Valve Endocarditis
Epidemiology, Microbiology, and Pathophysiology of PVE
Diagnostic Workout
FDG PET/CT and PET/MR Imaging
Specific Technical Considerations
Patient Preparation
Radiopharmaceutical: Administered Activity
Concomitant Treatments
Other Special Considerations
Image Acquisition Protocol and Postprocessing
Image Reconstruction
Image Quality Assessment
Image Analysis and Interpretation Criteria
Overall Clinical Performance
Extra-Cardiac Manifestations
Multidisciplinary Discussion of Imaging Results
Conclusion
References
13: Native-Valve Endocarditis
Introduction
Pathophysiology
Epidemiology
Clinical Presentation and Diagnosis
Management
FDG-PET/CT Imaging
Extracardiac Manifestations of Infective Endocarditis
Prognostic Value
Conclusion
References
14: Cardiovascular Implantable Electronic Device Infection
Introduction
Cardiac Implantable Electronic Device (CIED) Infections
Left Ventricular Assist Device (LVAD) Infection
Diagnostic Work-Up of CIED and LVAD Infections
Clinical Signs
Microbiology
Imaging
Echocardiography
Cardiac CT
Endocarditis Team
Prognosis
FDG PET/CT
Basic Principles
Patient Preparation
Tracer Administration
Imaging Procedure
Interpretation Criteria
CIED Infections
LVAD Infections
Comparison with WBC SPECT/CT
Perspectives
Conclusions
References
15: Vascular Graft Infection
Introduction
Frequency, Pathogenesis, and Clinical Presentation
Diagnosis of VGI
Ultrasonography (US)
Computed Tomography Angiography (CTA)
Magnetic Resonance Angiography (MRA)
Radiolabeled White Blood Cell (WBC) Scintigraphy
FDG PET/CT in VGI
PET/CT Acquisition Protocol
Interpretation Criteria/Methods
Limitations and Pitfalls
Monitoring Therapy
Conclusion
References
16: Left Ventricular Assist Device Infection
Epidemiology
Pathophysiology
VAD-Specific Infection: Percutaneous Driveline Infections
VAD-Specific Infection: Pump Pocket and Cannula Infections
VAD-Related Infections
Microbiology
Treatment
Diagnostic Strategies
Factors That Affect Image Quality and Interpretation
Preparation and Image Acquisition
Interpretation and Reporting
Clinical Cases
Conclusion
References
17: Sternal Wound Infection and Mediastinitis
Introduction
Epidemiology
Pathogenesis
Treatments
Clinical Presentation
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography
Imaging Protocol
Image Interpretation
Conclusion
References
Part IV: Atherosclerotic Disease
18: Atherosclerosis Imaging
Introduction
Atherosclerotic Plaque Biology
Inflammation in Atherosclerosis
Noninvasive Molecular Imaging of Atherosclerosis Inflammation with 18F-FDG
Impact of Therapies on Atherosclerosis Inflammation Measured with 18F-FDG
Molecular Imaging of Coronary Inflammation
Microcalcification Activity and Other Targets for Molecular Imaging of Atherosclerotic Plaque
Hybrid PET/Magnetic Resonance Imaging (MRI) Systems
Multimodality Molecular Imaging Approaches
Clinical Applications
Conclusion
References
19: Coronary Artery Disease
Introduction
18F-Fluorodeoxyglucose (FDG) Imaging of Metabolic Activity
FDG Imaging for CAD Detection and Risk Prediction
Limitations of FDG Imaging in Coronary Atherosclerosis
Standardizing FDG Protocols for Improved Imaging of Coronary Atherosclerosis
18F-NaF Imaging of Microcalcification
Clinical Utility of NaF in Coronary Atherosclerotic Imaging
NaF Imaging in Prospective Risk Assessment
Limitations and Future Directions
68Ga-Pentixafor Imaging of CXCR4 Inflammation
The CXCR4 Signaling Pathway
Nuclear Imaging of CXCR4 in Coronary Atherosclerosis
Comparison of 18F-FDG and 68Ga-Pentixafor Imaging
Clinical Applications of CXCR4-Targeted Imaging
Emerging Tracers
References
20: Viability Imaging
Introduction
Viability: Back to Basics: Understanding the Terminology
Clinical Applications for Viability
Nuclear Methods for Assessing Viability
SPECT
99mTc-labelled agents
Thallium-201
PET
FDG PET Imaging Protocols
Image Interpretation of FDG
Cardiovascular Magnetic Resonance Imaging Methods for Assessing Viability
End Diastolic Wall Thickness To Predict Functional Recovery
Dobutamine CMR for Assessment of Contractile Reserve to Predict Functional Recovery
Transmural Extent of Scar by LGE Imaging to Predict Functional Recovery
Future Prospects for Metabolic and Hybrid CMR to Predict Functional Recovery
Evidence for the Role of Viability Imaging
Future Directions
Conclusion
References
Part V: FDG-PET in Special Populations
21: Pediatrics Cardiovascular FDG-PET Imaging
Introduction
Minimization of Radiation Exposure
Eliminating Unnecessary Examinations
Reducing Radiotracer Dose
Optimizing CT Imaging Parameters and Reducing Scan Range
18F-FDG PET/CT Protocols
Typical 18F-FDG PET/CT Imaging Session
Myocardial Viability
Myocardial Suppression
18F-FDG PET/CT and Pediatric Sedation
Pediatric 18F-FDG PET/MR Cardiovascular Imaging
Kawasaki Disease
Anomalous Coronaries
Congenital Heart Disease
Transposition of the Great Arteries
Single Ventricle and Hypoplastic Left Heart Syndrome
Modified Blalock–Taussig Shunt
Bidirectional Glenn (Cavobipulmonary) Shunt
Norwood Staged Procedures
Jatene Arterial Switch Procedure
Right Ventricle–Pulmonary Artery (RV-PA) Conduit
Tetralogy of Fallot
Cardiovascular Infections
Infections Related to Sternotomy
Congenital Heart Disease Repair
Fever of Unknown Origin
Ventricular Assist Devices
Cardiac Implantable Electronic Devices
Pericardial Disease
Conclusion
References
22: FDG-PET/CT in Heart Transplant
Introduction
Pretransplant Screening
Posttransplantation Graft-Related Complications
Posttransplantation Non–Graft-Related Complications
Infections
Malignancies
Role of FDG-PET/CT in Detection, Staging, and Response Assessment of PTLD
Role of FDG-PET/CT in Detection and Staging of PTLD
Role of FDG-PET/CT in Response Assessment of PTLD
Prognostic Role of Baseline FDG PET/CT in PTLD
Conclusion
References
Part VI: Variants and Cases
23: Normal Variants, Not-So-Normal Variants, and Pitfalls of FDG-PET in Cardiovascular Imaging
Introduction
Patterns of Myocardial Uptake
Left Ventricular Uptake
Right Ventricular Uptake
Atrial Uptake
Pitfalls
Conclusion
References
24: Cardiovascular FDG-PET Atlas of Cases
Case 1
Initial Evaluation
Follow-Up
Teaching Point
Case 2
Initial Evaluation
Teaching Point
Case 3
Initial Evaluation
Follow-Up
Teaching Point
Case 4
Initial Evaluation
Follow-Up
Teaching Point
Case 5
Initial Evaluation
Follow-Up
Teaching Point
Case 6
Initial Evaluation
Follow-Up (1)
Follow-Up (2)
Follow-Up (3)
Teaching Point
Case 7
Initial Evaluation
Follow-Up
Teaching Point
Case 8
Initial Evaluation
Follow-Up
Teaching Point
Case 9
Initial Evaluation
Follow-Up
Teaching Point
Case 10
Initial Evaluation
Follow-Up
Teaching Point
Case 11
Initial Evaluation
Follow-Up
Teaching Point
Case 12
Initial Evaluation
Follow-Up
Teaching Point
Case 13
Initial Evaluation
Follow-Up (1)
Follow-Up (2)
Follow-Up (3)
Teaching Point
Case 14
Initial Evaluation
Follow-Up
Teaching Point
Case 15
Initial Evaluation
Follow-Up (1)
Follow-Up (2)
Teaching Point
Case 16
Initial Evaluation
Follow-Up
Teaching Point
Case 17
Initial Evaluation
Follow-Up
Teaching Point
References
Index
