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Ferko N, Priest S, Almuallem L, Walczyk Mooradally A, Wang D, Oliva Ramirez A, Szabo E, Cabra A. Economic and healthcare resource utilization assessments of PET imaging in Coronary Artery Disease diagnosis: a systematic review and discussion of opportunities for future economic evaluations. J Med Econ 2024; 27:715-729. [PMID: 38650543 DOI: 10.1080/13696998.2024.2345507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
AIMS This systematic literature review (SLR) consolidated economic and healthcare resource utilization (HCRU) evidence for positron emission tomography (PET) and single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to inform future economic evaluations. MATERIALS AND METHODS An electronic search was conducted in MEDLINE, Embase, and Cochrane databases from 2012-2022. Economic and HCRU studies in adults who underwent PET- or SPECT-MPI for coronary artery disease (CAD) diagnosis were eligible. A qualitative methodological assessment of existing economic evaluations, HCRU, and downstream cardiac outcomes was completed. Exploratory meta-analyses of clinical outcomes were performed. RESULTS The search yielded 13,439 results, with 71 records included. Economic evaluations and comparative clinical trials were limited in number and outcome types (HCRU, downstream cardiac outcomes, and diagnostic performance) assessed. No studies included all outcome types and only one economic evaluation linked diagnostic performance to HCRU. The meta-analyses of comparative studies demonstrated significantly higher rates of early- and late-invasive coronary angiography and revascularization for PET- compared to SPECT-MPI; however, the rate of repeat testing was lower with PET-MPI. The rate of acute myocardial infarction was lower, albeit non-significant with PET- vs. SPECT-MPI. LIMITATIONS AND CONCLUSIONS This SLR identified economic and HCRU evaluations following PET- and SPECT-MPI for CAD diagnosis and determined that existing studies do not capture all pertinent outcome parameters or link diagnostic performance to downstream HCRU and cardiac outcomes, thus, resulting in simplified assessments of CAD burden. A limitation of this work relates to heterogeneity in study designs, patient populations, and follow-up times of existing studies. Resultingly, it was challenging to pool data in meta-analyses. Overall, this work provides a foundation for the development of comprehensive economic models for PET- and SPECT-MPI in CAD diagnosis, which should link diagnostic outcomes to HCRU and downstream cardiac events to capture the full CAD scope.
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Affiliation(s)
| | | | | | | | - Di Wang
- EVERSANA, Burlington, Canada
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Promteangtrong C, Jantarato A, Kunawudhi A, Kiatkittikul P, Siripongsatian D, Boonkawin N, Chotipanich C. Clinical impact of quantitative [ 15O] H 2O PET/CT myocardial perfusion imaging on decision-making regarding invasive management of coronary artery disease. J Nucl Cardiol 2022; 29:1887-1899. [PMID: 33826128 DOI: 10.1007/s12350-021-02604-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study was performed to determine the impact of oxygen-15-labeled water ([15O] H2O) positron emission tomography/computed tomography (PET/CT) myocardial perfusion imaging (MPI) on referral for invasive coronary angiography (ICA) and revascularization. METHODS This study involved 57 patients who underwent [15O] H2O PET/CT MPI for evaluation of coronary artery disease (CAD). Data of referral for ICA and revascularization, clinical symptoms, and cardiac events within 6 months after MPI were assessed. Logistic regression was used to determine the predictors for referral and revascularization. The diagnostic values of hyperemic myocardial blood flow (MBF) and coronary flow reserve (CFR) were calculated. RESULTS Normal and abnormal MPI findings were observed in 18 (32%) and 39 (68%) patients, respectively. The referral rate was significantly different between the normal and abnormal MPI groups (5.6% and 48.7%, respectively; P = .002). Revascularization rate of abnormal MPI group was 40.0%. There were significant differences of hyperemic MBF and CFR between patients with and without referral. Hyperemic MBF was significant predictor for referral (OR 15.24, 95% CI 3.39-68.55, P < .005) and revascularization (OR 28.57, 95% CI 3.08-265.33, P < .005). CONCLUSION [15O] H2O PET/CT MPI showed a clinical impact on decision-making regarding invasive procedure for management of CAD.
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Affiliation(s)
- Chetsadaporn Promteangtrong
- National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand.
| | - Attapon Jantarato
- National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand
| | - Anchisa Kunawudhi
- National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand
| | - Peerapon Kiatkittikul
- National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand
| | - Dheeratama Siripongsatian
- National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand
| | - Natphimol Boonkawin
- National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand
| | - Chanisa Chotipanich
- National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand
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Synthesis and Evaluation of 18F-Labeled Fluoroalkyl Triphenylphosphonium Salts as Mitochondrial Voltage Sensors in PET Myocardial Imaging. Methods Mol Biol 2021. [PMID: 34118031 DOI: 10.1007/978-1-0716-1262-0_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
We have previously reported that radiolabeled phosphonium cations accumulate in the mitochondria down a transmembrane potential gradient. We present an optimized procedure for synthesis of three [18F]-labeled fluoroalkyl triphenylphosphonium salts ([18F]FATPs) via two-step simple nucleophilic substitution reactions to develop new myocardial imaging agents for positron emission tomography (PET) . The total reaction time of [18F]FATPs was within 60 min, and the overall decay-corrected radiochemical yield was approximately 15-30% (decay corrected). Radiochemical purity was >98% according to analytical high-performance liquid chromatography (HPLC) . The specific activity of [18F]FATPs was >6.1 TBq/μmol. The [18F]FATPs exhibited higher first-pass extraction fraction values in isolated heart, higher uptake in the myocardium, and a more rapid clearance from the liver and lung than [13N]NH3 in normal rats. The images from rats with an occluded left coronary artery demonstrated sharply defined myocardial defects in the corresponding area of the myocardium. This imaging technology may enable high-throughput, multiple studies daily and wide distribution of PET myocardial studies in clinic.
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Hosseinzadeh E, Ghodsirad MA, Alirezaei T, Arfenia M, Amoiee M, Norouzi GH. Comparing left ventricular mechanical dyssynchrony between diabetic and non-diabetic patients with normal gated SPECT MPI. Int J Cardiovasc Imaging 2021; 38:249-256. [PMID: 34313890 DOI: 10.1007/s10554-021-02358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study was to employ phase analysis to diagnose left ventricular mechanical dyssynchrony (LVMD) in asymptomatic patients with diabetes mellitus type 2 and normal perfusion study which may help prevent diabetic cardiomyopathy. Ninety-three consecutive patients with known type 2 diabetes and 81 age- and gender- matched patients without diabetes who were candidates for SPECT-MPI were considered as the control group. The presence of LVMD as an possible risk factor for cardiomyopathy- was determined using phase analysis for each scan with quantitative gated SPECT (QGS) and corridor4DM (4DM) software. All outcomes such as phase bandwidth (PBW) and phase standard deviation (PSD) were compared between the two groups. A total of 174 patients were included in the study. There were no statistically significant difference regarding demographic factors between the two groups (P > 0.05). PBW showed statistically significant differences (increased in diabetics) between the control and diabetic patients (P < 0.05). Kruskal Wallis analysis revealed that as the duration of diabetes is prolonged, especially more than 15 years, the probability of LVMD is increased as well (P = 0.021). Fraction of asymptomatic diabetic patients with normal ejection fraction and gated SPECT MPI-especially those with prolonged diabetes- might have some degrees of LVMD. Phase analysis can detect this which in turn may prevent progress into heart failure.
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Affiliation(s)
- E Hosseinzadeh
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M A Ghodsirad
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - T Alirezaei
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Cardiology Department of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Arfenia
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Amoiee
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - G H Norouzi
- Clinical Research Development Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Nuclear Medicine Department, Shohada Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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Abstract
PURPOSE OF REVIEW This review discusses similarities and differences between cardiac positron emission tomography (PET), absolute myocardial blood flow, and flow reserve with invasive fractional flow reserve (FFR). RECENT FINDINGS Fundamentally, cardiac PET measures absolute myocardial blood flow whereas FFR provides a relative flow reserve. Cardiac PET offers a non-invasive and therefore lower risk alternative, able to image the entire left ventricle regardless of coronary anatomy. While cardiac PET can provide unique information about the subendocardium, FFR pullbacks offer unparalleled spatial resolution. Both diagnostic tests provide a highly repeatable and technically successful index of coronary hemodynamics that accounts for the amount of distal myocardial mass, albeit only indirectly with FFR. The randomized evidence base for FFR and its associated cost effectiveness remains unsurpassed. Cardiac PET and FFR have been intertwined since the very development of FFR over 25 years ago. Recent work has emphasized the ability of both techniques to guide revascularization decisions by high-quality physiology. In the past few years, cardiac PET has expanded its evidence base regarding clinical outcomes, whereas FFR has solidified its position in randomized studies as the invasive reference standard.
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Affiliation(s)
- Nils P. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
- Memorial Hermann Hospital, Houston, TX USA
| | - K. Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
- Memorial Hermann Hospital, Houston, TX USA
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Werner RA, Chen X, Rowe SP, Lapa C, Javadi MS, Higuchi T. Recent paradigm shifts in molecular cardiac imaging—Establishing precision cardiology through novel 18F-labeled PET radiotracers. Trends Cardiovasc Med 2020; 30:11-19. [DOI: 10.1016/j.tcm.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/30/2022]
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Park H, Kim HS, Hong YJ, Min JJ, Kim HB, Kim MC, Sim DS, Kim JH, Kim DY, Lee JS, Ahn Y, Jeong MH. Therapeutic Effect of Fimasartan in a Rat Model of Myocardial Infarction Evaluated by Cardiac Positron Emission Tomography with [ 18F]FPTP. Chonnam Med J 2019; 55:109-115. [PMID: 31161123 PMCID: PMC6536431 DOI: 10.4068/cmj.2019.55.2.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/13/2019] [Accepted: 04/02/2019] [Indexed: 11/06/2022] Open
Abstract
We evaluated the efficacy of fimasartan on perfusion defects and infarction size in an animal model of myocardial infarction (MI), with echocardiography and positron emission tomography (PET) using a 18F-labeled phosphonium cation (5-[18F]-fluoropentyl-triphenylphosphonium salt, [18F]FPTP) as a mitochondrial voltage sensor for myocardial imaging. We induced MI in 33 rats by ligation of the left coronary artery, and checked their cardiac PET image using [18F]FPTP for evaluation of myocardial perfusion. Rats were grouped into 3 groups according to their administered drugs: no drug (n=11), fimasartan 3 mg/kg (n=10), and fimasartan 10 mg/kg (n=12). Each designated drug was administered for 4 weeks, and follow-up PET and histologic examinations were done. In the PET analysis, a perfusion defect size was markedly improved in fimasartan 10 mg/kg group (35.9±7.0% to 28.4±6.9%, p<0.001), whereas treatment with fimasartan 3 mg/kg induced only an insignificant reduction of perfusion defect size (35.9±7.9% to 33.9±7.3%, p=0.095). Using 2, 3, 5-triphenyltetrazolium chloride staining, infarction size was the largest in the control group (36.5±8.3%), and was insignificantly lower in the fimasartan 3 mg/kg group (31.5±6.5%, p for the difference between the control group=0.146) and was significantly lower in the fimasartan 10 mg/kg group (26.3±7.6%, p for the difference between the control group=0.011). PET imaging using a 18F-labeled mitochondrial voltage sensor, [18F]FPTP, is useful in evaluation and monitoring of myocardial perfusion states, and treatment with fimasartan decreases the infarction size in animal MI model.
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Affiliation(s)
- Hyukjin Park
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyeon Sik Kim
- Institute for Biomedical Science, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young Joon Hong
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Han Byul Kim
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dong-Yeon Kim
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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Said SA, Agool A, Moons AH, Basalus MW, Wagenaar NR, Nijhuis RL, Schroeder-Tanka JM, Slart RH. Incidental congenital coronary artery vascular fistulas in adults: Evaluation with adenosine- 13N-ammonia PET-CT. World J Cardiol 2018; 10:153-164. [PMID: 30386493 PMCID: PMC6205851 DOI: 10.4330/wjc.v10.i10.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the functionality of congenital coronary artery fistulas (CAFs) using adenosine stress 13N-ammonia positron emission tomography computed tomography (PET-CT). METHODS Congenital CAFs were incidentally detected during coronary angiography (CAG) procedures in 11 adult patients (six males and five females) with a mean age of 64.3 years (range 41-81). Patients were collected from three institutes in the Netherlands. The characteristics of the fistulas (origin, pathway and termination), multiplicity of the origins and pathways of the fistulous vessels were assessed by CAG. Five patients underwent adenosine pharmacologic stress 13N-ammonia PET-CT to assess myocardial perfusion and the functional behavior of the fistula. RESULTS Eleven patients with 12 CAFs, 10 unilateral and one bilateral, originating from the left anterior descending coronary artery (n = 8), right coronary artery (n = 2) and circumflex (n = 2). All fistulas were of the vascular type, terminating into either the pulmonary artery (n = 11) or coronary sinus (n = 1). The CAG delineated the characteristics of the fistula (origin, pathway and termination). Multiplicity of the origins and pathways of the fistulous vessels were common in most fistulas (8/12, 67% and 9/12, 75%, respectively). Multiplicity was common among the different fistula components (23/36, 64%). Adenosine pharmacologic stress 13N-ammonia PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection fraction. CONCLUSION PET-CT may be helpful for assessing the functional status of congenital CAFs in selected patients regarding clinical decision-making. Studies with a larger patient series are warranted.
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Affiliation(s)
- Salah Am Said
- Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands.
| | - Aly Agool
- Department of Nuclear Medicine, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Arno Hm Moons
- Department of Cardiology, Slotervaart Hospital, Amsterdam 1066 EC, North Holland, The Netherlands
| | - Mounir Wz Basalus
- Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Nils Rl Wagenaar
- Department of Nuclear Medicine, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Rogier Lg Nijhuis
- Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Jutta M Schroeder-Tanka
- Department of Cardiology, Hospital Onze Lieve Vrouwe Gasthuis, Location West, Amsterdam 1061 AE, North Holland, The Netherlands
| | - Riemer Hja Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
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Kim DY, Cho SG, Bom HS. Emerging Tracers for Nuclear Cardiac PET Imaging. Nucl Med Mol Imaging 2018; 52:266-278. [PMID: 30100939 PMCID: PMC6066491 DOI: 10.1007/s13139-018-0521-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/05/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022] Open
Abstract
Myocardial perfusion imaging using positron emission tomography (PET) has several advantages over single photon emission computed tomography (SPECT). The recent advances in SPECT technology have shown promise, but there is still a large need for PET in the clinical management of coronary artery disease (CAD). Especially, absolute quantification of myocardial blood flow (MBF) using PET is extremely important. In spite of considerable advances in the diagnosis of CAD, novel PET radiopharmaceuticals remain necessary for the diagnosis of CAD because clinical use of current cardiac radiotracers is limited by their physical characteristics, such as decay mode, emission energy, and half-life. Thus, the use of a radioisotope that has proper characteristics and a proper half-life to develop myocardial perfusion agents could overcome these limitations. In this review, the current state of cardiac PET and a general overview of novel 18F or 68Ga-labeled radiotracers, including their radiosynthesis, in vivo characterization, and evaluation, are provided. The future perspectives are discussed in terms of their potential usefulness based on new image analysis methods and hybrid imaging.
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Affiliation(s)
- Dong-Yeon Kim
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
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Chen S, Zhao Z, Zhang Y, Fang W, Lu J, Zhang X. Effect of methoxy group position on biological properties of 18 F–labeled benzyl triphenylphosphonium cations. Nucl Med Biol 2017; 49:16-23. [DOI: 10.1016/j.nucmedbio.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/23/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
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Chalian H, O'Donnell JK, Bolen M, Rajiah P. Incremental value of PET and MRI in the evaluation of cardiovascular abnormalities. Insights Imaging 2016; 7:485-503. [PMID: 27221975 PMCID: PMC4956622 DOI: 10.1007/s13244-016-0494-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/01/2016] [Accepted: 04/22/2016] [Indexed: 12/11/2022] Open
Abstract
Abstract The cardiovascular system is affected by a wide range of pathological processes, including neoplastic, inflammatory, ischemic, and congenital aetiology. Magnetic resonance imaging (MRI) and positron emission tomography (PET) are state-of-the-art imaging modalities used in the evaluation of these cardiovascular disorders. MRI has good spatial and temporal resolutions, tissue characterization and multi-planar imaging/reconstruction capabilities, which makes it useful in the evaluation of cardiac morphology, ventricular and valvar function, disease characterization, and evaluation of myocardial viability. FDG-PET provides valuable information on the metabolic activity of the cardiovascular diseases, including ischemia, inflammation, and neoplasm. MRI and FDG-PET can provide complementary information on the evaluation of several cardiovascular disorders. For example, in cardiac masses, FDG-PET provides the metabolic information for indeterminate cardiac masses. MRI can be used for localizing and characterizing abnormal hypermetabolic foci identified incidentally on PET scan and also for local staging. A recent advance in imaging technology has been the development of integrated PET/MRI systems that utilize the advantages of PET and MRI in a single examination. The goal of this manuscript is to provide a comprehensive review on the incremental value of PET and MRI in the evaluation of cardiovascular diseases. Main Messages • MRI has good spatial and temporal resolutions, tissue characterization, and multi-planar reconstruction • FDG-PET provides valuable information on the metabolic activity of cardiovascular disorders • PET and MRI provide complementary information on the evaluation of cardiovascular disorders Electronic supplementary material The online version of this article (doi:10.1007/s13244-016-0494-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hamid Chalian
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - James K O'Donnell
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Michael Bolen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA. .,Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390, USA.
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Radiolabeled Phosphonium Salts as Mitochondrial Voltage Sensors for Positron Emission Tomography Myocardial Imaging Agents. Nucl Med Mol Imaging 2016; 50:185-95. [PMID: 27540422 DOI: 10.1007/s13139-016-0397-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 02/02/2023] Open
Abstract
Despite substantial advances in the diagnosis of cardiovascular disease, (18)F-labeled positron emission tomography (PET) radiopharmaceuticals remain necessary to diagnose heart disease because clinical use of current PET tracers is limited by their short half-life. Lipophilic cations such as phosphonium salts penetrate the mitochondrial membranes and accumulate in mitochondria of cardiomyocytes in response to negative inner-transmembrane potentials. Radiolabeled tetraphenylphosphonium cation derivatives have been developed as myocardial imaging agents for PET. In this review, a general overview of these radiotracers, including their radiosynthesis, in vivo characterization, and evaluation is provided and clinical perspectives are discussed.
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Radiosynthesis and evaluation of 18F-labeled aliphatic phosphonium cations as a myocardial imaging agent for positron emission tomography. Nucl Med Commun 2015; 36:747-54. [DOI: 10.1097/mnm.0000000000000315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Kim DY, Kim HS, Reder S, Zheng JH, Herz M, Higuchi T, Pyo AY, Bom HS, Schwaiger M, Min JJ. Comparison of 18F-Labeled Fluoroalkylphosphonium Cations with 13N-NH3 for PET Myocardial Perfusion Imaging. J Nucl Med 2015; 56:1581-6. [PMID: 26069304 DOI: 10.2967/jnumed.115.156794] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/29/2015] [Indexed: 01/16/2023] Open
Abstract
UNLABELLED Despite substantial advances in the diagnosis of cardiovascular disease, there is a need for 18F-labeled myocardial perfusion agents for the diagnosis of ischemic heart disease because current PET tracers for myocardial perfusion imaging have a short half-life that limits their widespread clinical use in PET. Thus, 18F-labeled fluoroalkylphosphonium derivatives (18F-FATPs), including (5-18F-fluoropentyl)triphenylphosphonium cation (18F-FPTP), (6-18F-fluorohexyl)triphenylphosphonium cation (18F-FHTP), and (2-(2-18F-fluoroethoxy)ethyl)triphenylphosphonium cation (18F-FETP), were synthesized. The myocardial extraction and image quality of the 18F-FATPs were compared with those of 13N-NH3 in rat models. METHODS The first-pass extraction fraction (EF) values of the 18F-FATPs (18F-FPTP, 18F-FHTP, 18F-FETP) and 13N-NH3 were measured in isolated rat hearts perfused with the Langendorff method (flow velocities, 0.5, 4.0, 8.0, and 16.0 mL/min). Normal and myocardial infarction rats were imaged with small-animal PET after intravenous injection of 37 MBq of 18F-FATPs and 13N-NH3. To determine pharmacokinetics, a region of interest was drawn around the heart, and time-activity curves of the 18F-FATPs and 13N-NH3 were generated to obtain the counts per pixel per second. Defect size was analyzed on the basis of polar map images of 18F-FATPs and 13N-NH3. RESULTS The EF values of 18F-FATPs and 13N-NH3 were comparable at low flow velocity (0.5 mL/min), whereas at higher flows EF values of 18F-FATPs were significantly higher than those of 13N-NH3 (4.0, 8.0, and 16.0 mL/min, P<0.05). Myocardium-to-liver ratios of 18F-FPTP, 18F-FHTP, 18F-FETP, and 13N-NH3 were 2.10±0.30, 4.36±0.20, 3.88±1.03, and 0.70±0.09, respectively, 10 min after injection, whereas myocardium-to-lung ratios were 5.00±0.25, 4.33±0.20, 7.98±1.23, and 2.26±0.14, respectively. Although 18F-FATPs and 13N-NH3 sharply delineated myocardial perfusion defects, defect size on the 13N-NH3 images was significantly smaller than on the 18F-FATP images soon after tracer injection (0-10 min, P=0.027). CONCLUSION 18F-FATPs exhibit higher EF values and more rapid clearance from the liver and lung than 13N-NH3 in normal rats, which led to excellent image quality in a rat model of coronary occlusion. Therefore, 18F-FATPs are promising new PET radiopharmaceuticals for myocardial perfusion imaging.
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Affiliation(s)
- Dong-Yeon Kim
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea; and
| | - Hyeon Sik Kim
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea; and
| | - Sybille Reder
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Jin Hai Zheng
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea; and
| | - Michael Herz
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - A Young Pyo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea; and
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea; and
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea; and
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Turchetti G, Kroes MA, Lorenzoni V, Trieste L, Chapman AM, Sweet AC, Wilson GI, Neglia D. The cost–effectiveness of diagnostic cardiac imaging for stable coronary artery disease. Expert Rev Pharmacoecon Outcomes Res 2015; 15:625-33. [DOI: 10.1586/14737167.2015.1051037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kim DY, Min JJ. Synthesis and evaluation of ¹⁸F-labeled fluoroalkyl triphenylphosphonium salts as mitochondrial voltage sensors in PET myocardial imaging. Methods Mol Biol 2015; 1265:59-72. [PMID: 25634267 DOI: 10.1007/978-1-4939-2288-8_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We have previously reported that radiolabeled phosphonium cations accumulate in the mitochondria down a transmembrane potential gradient. We present an optimized procedure for synthesis of three 18F-labeled fluoroalkyl triphenylphosphonium salts ([18F]FATPs) via two-step simple nucleophilic substitution reactions to develop new myocardial imaging agents for positron emission tomography (PET). The total reaction time of [18F]FATPs was within 60 min, and the overall decay-corrected radiochemical yield was approximately 15-30 % (decay corrected). Radiochemical purity was >98 % according to analytical high-performance liquid chromatography (HPLC). The specific activity of [18F]FATPs was >6.1 TBq/μmol. The micro-PET imaging studies in rats showed an initial spike of radioactivity, followed by myocardial retention and rapid clearance from background. The images from rats with an occluded left coronary artery demonstrated sharply defined myocardial defects in the corresponding area of the myocardium. This imaging technology may enable high throughput, multiple studies daily and wide distribution of PET myocardial studies in clinic.
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Affiliation(s)
- Dong-Yeon Kim
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
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Kim DY, Kim HS, Jang HY, Kim JH, Bom HS, Min JJ. Comparison of the Cardiac MicroPET Images Obtained Using [(18)F]FPTP and [(13)N]NH3 in Rat Myocardial Infarction Models. ACS Med Chem Lett 2014; 5:1124-8. [PMID: 25313324 DOI: 10.1021/ml500251z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/10/2014] [Indexed: 11/29/2022] Open
Abstract
The short half-life of current positron emission tomography (PET) cardiac tracers limits their widespread clinical use. We previously developed a (18)F-labeled phosphonium cation, [(18)F]FPTP, that demonstrated sharply defined myocardial defects in a corresponding infarcted myocardium. The aim of this study was to compare the image properties of PET scans obtained using [(18)F]FPTP with those obtained using [(13)N]NH3 in rat myocardial infarction models. Perfusion abnormality was analyzed in 17 segments of polar map images. The myocardium-to-liver and myocardium-to-lung ratios of [(18)F]FPTP were 10.48 and 2.65 times higher, respectively, than those of [(13)N]NH3 in images acquired 30 min after tracer injection. The myocardial defect size measured by [(18)F]FPTP correlated more closely with the hypoperfused area measured by quantitative 2,3,5-triphenyltetrazolium chloride staining (r = 0.89, P < 0.01) than did [(13)N]NH3 (r = 0.84, P < 0.01). [(18)F]FPTP might be useful as a replacement for the myocardial agent [(13)N]NH3 in cardiac PET/CT applications.
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Affiliation(s)
- Dong-Yeon Kim
- Department
of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyeon Sik Kim
- Department
of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hwa Youn Jang
- Department
of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ju Han Kim
- Department
of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Hee-Seung Bom
- Department
of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jung-Joon Min
- Department
of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Azhdarinia A, Ghosh S. Nuclear Imaging with Nanoparticles. Nanomedicine (Lond) 2014. [DOI: 10.1201/b17246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Zhao Z, Yu Q, Mou T, Liu C, Yang W, Fang W, Peng C, Lu J, Liu Y, Zhang X. Highly Efficient One-Pot Labeling of New Phosphonium Cations with Fluorine-18 as Potential PET Agents for Myocardial Perfusion Imaging. Mol Pharm 2014; 11:3823-31. [DOI: 10.1021/mp500216g] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zuoquan Zhao
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, 19 Xinjiekou Outer Street, Beijing 100875, China
| | - Qian Yu
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, 19 Xinjiekou Outer Street, Beijing 100875, China
| | - Tiantian Mou
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, 19 Xinjiekou Outer Street, Beijing 100875, China
| | - Chang Liu
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, 19 Xinjiekou Outer Street, Beijing 100875, China
- Center
for Molecular Imaging and Translational Medicine, State Key Laboratory
of Molecular Vaccinology and Molecular Diagnostics, School of Public
Health, Xiamen University, Xiang’an South Road, Xiamen 361102, China
| | - Wenjiang Yang
- Key
Laboratory of Nuclear Radiation and Nuclear Energy Technology, Institute
of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Fang
- Department
of Nuclear Medicine, Cardiovascular Institute and FuWai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Cheng Peng
- PET Center
of Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jie Lu
- Key
Laboratory of Radiopharmaceuticals, Ministry of Education, College
of Chemistry, Beijing Normal University, 19 Xinjiekou Outer Street, Beijing 100875, China
| | - Yu Liu
- Key
Laboratory of Nuclear Radiation and Nuclear Energy Technology, Institute
of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Xianzhong Zhang
- Center
for Molecular Imaging and Translational Medicine, State Key Laboratory
of Molecular Vaccinology and Molecular Diagnostics, School of Public
Health, Xiamen University, Xiang’an South Road, Xiamen 361102, China
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Kim DY, Kim HS, Le UN, Jiang SN, Kim HJ, Lee KC, Woo SK, Chung J, Kim HS, Bom HS, Yu KH, Min JJ. Evaluation of a Mitochondrial Voltage Sensor, (18F-Fluoropentyl)Triphenylphosphonium Cation, in a Rat Myocardial Infarction Model. J Nucl Med 2012; 53:1779-85. [DOI: 10.2967/jnumed.111.102657] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Quantification of myocardial blood flow with 82Rb positron emission tomography: clinical validation with 15O-water. Eur J Nucl Med Mol Imaging 2012; 39:1037-47. [PMID: 22398957 PMCID: PMC3342496 DOI: 10.1007/s00259-012-2082-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 02/01/2012] [Indexed: 12/22/2022]
Abstract
Purpose Quantification of myocardial blood flow (MBF) with generator-produced 82Rb is an attractive alternative for centres without an on-site cyclotron. Our aim was to validate 82Rb-measured MBF in relation to that measured using 15O-water, as a tracer 100% of which can be extracted from the circulation even at high flow rates, in healthy control subject and patients with mild coronary artery disease (CAD). Methods MBF was measured at rest and during adenosine-induced hyperaemia with 82Rb and 15O-water PET in 33 participants (22 control subjects, aged 30 ± 13 years; 11 CAD patients without transmural infarction, aged 60 ± 13 years). A one-tissue compartment 82Rb model with ventricular spillover correction was used. The 82Rb flow-dependent extraction rate was derived from 15O-water measurements in a subset of 11 control subjects. Myocardial flow reserve (MFR) was defined as the hyperaemic/rest MBF. Pearson’s correlation r, Bland-Altman 95% limits of agreement (LoA), and Lin’s concordance correlation ρc (measuring both precision and accuracy) were used. Results Over the entire MBF range (0.66–4.7 ml/min/g), concordance was excellent for MBF (r = 0.90, [82Rb–15O-water] mean difference ± SD = 0.04 ± 0.66 ml/min/g, LoA = −1.26 to 1.33 ml/min/g, ρc = 0.88) and MFR (range 1.79–5.81, r = 0.83, mean difference = 0.14 ± 0.58, LoA = −0.99 to 1.28, ρc = 0.82). Hyperaemic MBF was reduced in CAD patients compared with the subset of 11 control subjects (2.53 ± 0.74 vs. 3.62 ± 0.68 ml/min/g, p = 0.002, for 15O-water; 2.53 ± 1.01 vs. 3.82 ± 1.21 ml/min/g, p = 0.013, for 82Rb) and this was paralleled by a lower MFR (2.65 ± 0.62 vs. 3.79 ± 0.98, p = 0.004, for 15O-water; 2.85 ± 0.91 vs. 3.88 ± 0.91, p = 0.012, for 82Rb). Myocardial perfusion was homogeneous in 1,114 of 1,122 segments (99.3%) and there were no differences in MBF among the coronary artery territories (p > 0.31). Conclusion Quantification of MBF with 82Rb with a newly derived correction for the nonlinear extraction function was validated against MBF measured using 15O-water in control subjects and patients with mild CAD, where it was found to be accurate at high flow rates. 82Rb-derived MBF estimates seem robust for clinical research, advancing a step further towards its implementation in clinical routine.
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Abstract
OBJECTIVE Cardiac positron emission tomography (PET)/CT imaging is a noninvasive procedure allowing the assessment of coronary artery disease (CAD). CT-based attenuation correction of PET data is essential for accurate quantitative analysis in PET/CT imaging. Coronary artery calcium scoring CT (CaScCT) is used as a noninvasive tool for the diagnosis of atherosclerosis in patients with medium risk for CAD. In addition to the CaScCT examination, current cardiac rest/stress NH3 or ¹⁸F-fluorodeoxyglucose viability PET/CT protocols incorporate a correlated low-dose CT scan for attenuation correction purposes (ACCT). As a result, the patient receives a non-negligible radiation dose. The aim of this study is to evaluate the possibility of using CaScCT images for AC of myocardial rest/stress/viability PET data with the aim of reducing patient dose. METHODS Since in cardiac PET/CT protocols, the CaScCT examination is usually reconstructed using a small field-of-view, the CaScCT data were reconstructed again with extended field-of-view (ExCaScCT) and used for AC of the corresponding PET data. The feasibility study was performed using 10 patients including four NH3 perfusion and six ¹⁸F-fluorodeoxyglucose viability examinations acquired on the Biograph TP 64 PET/CT scanner. The assessment of PET images corrected using both ACCT and ExCaScCT images was carried out through qualitative assessment performed by an expert nuclear medicine specialist in addition to the regression analysis and the Bland-Altman plots, and 20-segment myocardial bull's eye view analysis. RESULTS Despite the good agreement between PET images corrected using ACCT and ExCaScCT images as expressed by the correlation coefficient and slope of the regression line in viability (0.949 ± 0.041 and 0.994 ± 0.124) and stress perfusion examinations (0.944 ± 0.008 and 0.968 ± 0.055), the rest perfusion examinations had weak correlation (0.454 ± 0.203 and 0.757 ± 0.193). This is attributed to the fact that the CaScCT scan is performed immediately after the stress/viability ACCT in our protocol that leads to a small misalignment between the CaScCT and stress/viability ACCT images, whereas there is a large misalignment between the CaScCT and rest ACCT images. The bull's eye view analysis showed that the difference between the uptake values was larger in the inferior wall because of diaphragm motion. CONCLUSION Our preliminary results seem to suggest that the calcium score study could be used for attenuation correction of cardiac PET images, thus allowing the elimination of ACCT in viability and stress perfusion studies and as such reduce patient dose.
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Chambers JD, Neumann PJ, Buxton MJ. Does Medicare Have an Implicit Cost-Effectiveness Threshold? Med Decis Making 2010; 30:E14-27. [DOI: 10.1177/0272989x10371134] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Despite the huge cost of the program, the Centers for Medicare and Medicaid Services (CMS) has maintained a policy that cost-effectiveness is not considered in national coverage determinations (NCDs). Objective. To assess whether an implicit cost-effectiveness threshold exists and to determine if economic evidence has been considered in previous NCDs. Methods. A literature search was conducted to identify estimates of cost-effectiveness relevant to each NCD from 1999—2007 (n = 103). The economic evaluation that best represented each coverage decision was included in a review of the cost-effectiveness of medical interventions considered in NCDs. Results. Of the 64 coverage decisions determined to have a corresponding cost-effectiveness estimate, 49 were associated with a positive coverage decision and 15 with a noncoverage decision. Of the positive decisions, 20 were associated with an economic evaluation that estimated the intervention to be dominant (costs less and was more effective than the alternative), 12 with an incremental cost-effectiveness ratio (ICER) of less than $50,000, 8 with an ICER greater than $50,000 but less than $100,000, and 9 with an ICER greater than $100,000. Fourteen of the sample of 64 decision memos cited or discussed cost-effectiveness information. Conclusions. CMS is covering a number of interventions that do not appear to be cost-effective, suggesting that resources could be allocated more efficiently. Although the authors identified several instances where cost-effectiveness evidence was cited in NCDs, they found no clear evidence of an implicit threshold.
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Affiliation(s)
- James D. Chambers
- Health Economics Research Group, Brunel University, Uxbridge, UK, Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, Boston, Massachusetts,
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, Boston, Massachusetts
| | - Martin J. Buxton
- Received 21 September 2008 from Health Economics Research Group, Brunel University, Uxbridge, UK
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Wu YW, Chen YH, Wang SS, Jui HY, Yen RF, Tzen KY, Chen MF, Lee CM. PET assessment of myocardial perfusion reserve inversely correlates with intravascular ultrasound findings in angiographically normal cardiac transplant recipients. J Nucl Med 2010; 51:906-12. [PMID: 20484427 DOI: 10.2967/jnumed.109.073833] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Cardiac allograft vasculopathy (CAV) is the major determinant of long-term survival after heart transplantation. We aimed to evaluate the efficacy of PET as a noninvasive way to assess the early stages of CAV. METHODS Twenty-seven consecutive patients (20 men and 7 women; mean age +/- SD, 46 +/- 12 y) who had normal results on coronary angiography and normal left ventricular systolic function (ejection fraction >or= 60%) were enrolled at 2.5 +/- 2.1 y after transplantation. Myocardial blood flow (MBF) was assessed using dynamic (13)N-ammonia PET at rest and during adenosine-induced hyperemia, and myocardial perfusion reserve (MPR) was calculated as the ratio of hyperemic MBF to resting MBF. Regional (13)N-ammonia PET was assessed using a 5-point scoring system. The intravascular ultrasound (IVUS) measurements for the extent of intimal hyperplasia, including plaque volume index (calculated as [total plaque volume/total vessel volume] x 100%) and maximum area of stenosis, were compared with MPR by linear regression analysis. RESULTS In 27 angiographically normal cardiac transplant recipients, MBF at rest and during adenosine stress and MPR of the left anterior descending artery distribution correlated strongly with the other 2 coronary artery distribution territories (r >or= 0.97, P < 0.0001). Summed stress score and summed difference score showed a moderate inverse correlation with MPR (r = -0.41 and -0.49, respectively; P < 0.05) but not with IVUS measurements. MPR correlated inversely with plaque volume index (r = -0.40, P < 0.05) but not with maximal luminal stenosis as assessed by IVUS. In addition, MPR and IVUS measurements gradually inversely changed after heart transplantation (all P < 0.05). CONCLUSION This study confirms that CAV is a progressive process, diffusely involving the epicardial and microvascular coronary system. Plaque burden as determined by IVUS agrees well with MPR as assessed by PET in recipients with normal coronary angiography results. This finding suggests that dynamic (13)N-ammonia PET is clinically feasible for the early detection of CAV and can be used as a reliable marker of disease progression.
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Affiliation(s)
- Yen-Wen Wu
- National Taiwan University College of Medicine, Taipei, Taiwan
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Schwaiger M, Ziegler SI, Nekolla SG. PET/CT challenge for the non-invasive diagnosis of coronary artery disease. Eur J Radiol 2010; 73:494-503. [PMID: 20206454 DOI: 10.1016/j.ejrad.2009.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
This review will focus on the clinical potential of PET/CT for the characterization of cardiovascular diseases. We describe the technical challenges of combining instrumentation with very different imaging performance and discuss the clinical applications in the field of cardiology.
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Affiliation(s)
- Markus Schwaiger
- Klinikum rechts der Isar, Technische Universität München, Nuklearmedizinische Klinik und Poliklinik, München, Germany
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Recent advances and future trends in multimodality cardiac imaging. Heart Lung Circ 2010; 19:193-209. [PMID: 20138581 DOI: 10.1016/j.hlc.2009.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 11/24/2009] [Indexed: 01/07/2023]
Abstract
The cardiovascular imaging field has experienced marked growth and technical advancement in the past several decades. In the future, multimodality imaging will provide enhanced characterisation of disease states. Myocardial perfusion imaging will become more quantitative, permitting measurement of absolute blood flow and coronary flow reserves during stress states. A greater use of positron emission tomography (PET) can be expected for both assessing blood flow quantitatively and molecular imaging of atherosclerotic plaques and myocardial disease states. SPECT and PET imaging of myocardial metabolism and cardiac neuronal imaging have already shown great promise for identifying high-risk patients with coronary heart disease and nonischaemic cardiomyopathy. Further progress will occur in computed tomography imaging of the heart and coronary arteries and cardiac magnetic resonance imaging including quantitative estimates of coronary blood flow, coronary and peripheral vessel plaque characterisation, and detection of myocardial cellular dysfunction. Fusion imaging, in which two disparate image data sets are merged into one functional image, will become commonplace. Major breakthroughs in CV imaging will depend on discoveries in basic research, further refinement of instrumentation and software for image processing and analysis, and outcomes research demonstrating the worth of imaging technologies in reducing cardiovascular death and morbidity.
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Abstract
PET provides robust and reproducible measurements of regional myocardial blood flow in milliliters per minute per gram of tissue, providing unique pathophysiologic and diagnostic information on the function of the coronary macro- and microcirculation. There is compelling evidence to suggest that in many instances abnormalities of global myocardial perfusion are demonstrated in individuals with either coronary risk factors for coronary artery disease or different myocardial diseases in the absence of angiographically demonstrable stenosis of the epicardial coronary arteries. In this context, measurement of myocardial blood flow gives unique diagnostic information regarding the function of the coronary microcirculation and provides a quantitative surrogate endpoint against which the efficacy of treatments can be established.
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Affiliation(s)
- Paolo G Camici
- Medical Research Council, Clinical Sciences Centre and National Heart and Lung Institute, Imperial College, London, United Kingdom.
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