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J Nucl Med. 2008; 49 (Supplement 1):30P
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Cardiovascular: Basic Science

New Approaches Using SPECT, PET and Hybrid Imaging

Integration of infarct size, tissue perfusion and metabolism in a single cardiac PET-CT session – Evaluation in a porcine model of myocardial infarction

Riikka Lautamäki1, Karl Schuleri1, Amr Youssef1, Tetsuo Sasano1, Jennifer Merrill1, Stephan Nekolla1, M. Roselle Abraham1, Albert Lardo1 and Frank Bengel1

1 Johns Hopkins U, Baltimore, Maryland

119

Objectives: Multislice hybrid PET-CT scanners allow for combination of PET perfusion/metabolism imaging with CT angiography and delayed contrast enhancement(CE) for infarct(MI) detection. This may provide comprehensive bio-morphologic information about myocardial viability.

Methods: LAD balloon occlusion/reperfusion was employed in 9 animals.6 pigs underwent imaging using GE Discovery Rx VCT 24-72 hours after MI and 3 pigs were scanned >4 weeks from MI.Myocardial perfusion was determined with 13N-ammonia and metabolism with 18FDG. CE 64-slice CT was employed to obtain noninvasive angiography and, 10 minutes later, to detect myocardial delayed CE.PET and CT data were analyzed visually using a 17-segment model.

Results: LVEF was 45±11%.70/153 segments had PET perfusion defects. Among those,40 showed a matched reduction of FDG uptake and 30 showed a perfusion/metabolism mismatch. There was a significant difference (P=0.0006) between acute and chronic MI(28/30 mismatch segments in acute MI,probably due to inflammation).CT delayed CE revealed 55 segments with transmural(TM)infarction and 12 with non-TM infarction. While all PET matched defect segments showed TM infarcts at CT,evidence of infarct at CT was detected in 16/30(53%) PET mismatch segments. Finally,11/83(13%)normally perfused PET segments showed evidence of MI on CT.

Conclusions: Results of PET perfusion-metabolism imaging and late enhancement CT are complementary rather than competitive for myocardial viability assessment and can be integrated in a single PET-CT imaging session. Prospective clinical evaluation of PET-CT biomorphologic viability imaging is warranted to identify the predictive potential of different patterns of perfusion, metabolism and infarct transmurality.





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