Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies

2016 ◽  
Vol 12 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Christoph Gräni ◽  
Dominik C. Benz ◽  
Mathias Possner ◽  
Olivier F. Clerc ◽  
Fran Mikulicic ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Hybrid Imaging ◽  
Coronary Computed Tomography Angiography ◽  
Emission Tomography ◽  
Coronary Artery Anomalies ◽  
Positron Emission ◽  
Cardiac Hybrid Imaging

scholarly journals Characterization of functionally significant coronary artery disease by a coronary computed tomography angiography-based index: a comparison with positron emission tomography

2019 ◽  
Vol 20 (8) ◽  
pp. 897-905 ◽  
Author(s):  
Constantinos D Anagnostopoulos ◽  
Panagiotis K Siogkas ◽  
Riccardo Liga ◽  
Georgios Benetos ◽  
Teemu Maaniitty ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Emission Tomography ◽  
Coronary Computed Tomography ◽  
Positron Emission ◽  
Artery Disease

Abstract Aims To test the hypothesis that virtual functional assessment index (vFAI) is related with regional flow parameters derived by quantitative positron emission tomography (PET) and can be used to assess abnormal vasodilating capability in coronary vessels with stenotic lesions at coronary computed tomography angiography (CCTA). Methods and results vFAI, stress myocardial blood flow (MBF), and myocardial flow reserve (MFR) were assessed in 78 patients (mean age 62.2 ± 7.7 years) with intermediate pre-test likelihood of coronary artery disease (CAD). Coronary stenoses ≥50% were considered angiographically significant. PET was considered positive for significant CAD, when more than one contiguous segments showed stress MBF ≤2.3 mL/g/min for 15O-water or <1.79 mL/g/min for 13N-ammonia. MFR thresholds were ≤2.5 and ≤2.0, respectively. vFAI was lower in vessels with abnormal stress MBF (0.76 ± 0.10 vs. 0.89 ± 0.07, P < 0.001) or MFR (0.80 ± 0.10 vs. 0.89 ± 0.07, P < 0.001). vFAI had an accuracy of 78.6% and 75% in unmasking abnormal stress MBF and MFR in 15O-water and 82.7% and 71.2% in 13N-ammonia studies, respectively. Addition of vFAI to anatomical CCTA data increased the ability for predicting abnormal stress MBF and MFR in 15O-water studies [AUCccta + vfai = 0.866, 95% confidence interval (CI) 0.783–0.949; P = 0.013 and AUCccta + vfai = 0.737, 95% CI 0.648–0.825; P = 0.007, respectively]. An incremental value was also demonstrated for prediction of stress MBF (AUCccta + vfai = 0.887, 95% CI 0.799–0.974; P = 0.001) in 13N-ammonia studies. A similar trend was recorded for MFR (AUCccta + vfai = 0.780, 95% CI 0.632–0.929; P = 0.13). Conclusion vFAI identifies accurately the presence of impaired vasodilating capability. In combination with anatomical data, vFAI enhances the diagnostic performance of CCTA.

Abstract 19179: Prognostic Value of Combined Coronary Computed Tomography Angiography and Positron Emission Tomography Perfusion Imaging in Patients With Suspected Coronary Artery Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Teemu Maaniitty ◽  
Iida Soukka ◽  
Antti Saraste ◽  
Valtteri Uusitalo ◽  
Heikki Ukkonen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Perfusion Imaging ◽  
Coronary Computed Tomography Angiography ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Artery Disease

Objectives: Hybrid imaging using coronary computed tomography angiography (CTA) and positron emission tomography (PET) perfusion imaging accurately detects functionally significant coronary artery disease (CAD), but its optimal clinical use remains unknown. We studied the prognostic significance of strategy utilizing sequential CTA for exclusion of CAD followed by PET perfusion imaging for evaluating functional significance of any suspected obstructive lesions with a hybrid PET-CT device in symptomatic patients with suspected intermediate probability of CAD. Methods: We identified a cohort of 864 consecutive patients undergone hybrid PET-CT for the detection of suspected CAD. All patients had CTA and based on CTA findings, haemodynamic significance of any suspected stenoses was evaluated by PET perfusion imaging using H 2 15 O during adenosine-induced stress. Major adverse cardiac events (MACE) including death, myocardial infarction (MI) and unstable angina pectoris (UAP), were collected from the national healthcare statistics. Results: After exclusion of 97 patients undergone early (< 6 months) revascularization, 767 patients with age of 61 ± 10 years (41% males) were followed-up for a median time of 2.5 years. During the follow-up 6 deaths, 5 MIs and 3 UAPs occurred. In 462 patients, obstructive CAD was excluded based on CTA alone and the remaining patients with suspected stenoses (n=305, 39.8%) underwent PET perfusion imaging. In patients with normal or non-obstructive CTA annual incidence of MACE was only 0.16%, whereas in patients with suspected stenosis based on CTA it was 1.36% (p<0.05 vs. no stenosis). In patients with suspected obstructive lesion based on CTA, patients with normal PET perfusion had significantly lower event rate than patients with ischemia (0.54 vs. 2.78%, p<0.05). Conclusion: In patients with suspected obstructive CAD PET perfusion imaging after CT angiography is able to accurately identify those patients with high risk of future MACE. Sequential use of CTA and PET perfusion imaging appears powerful and safe strategy for targeting therapeutic procedures in high risk individuals.

The Potential Value of Hybrid Positron Emission Tomography/Dual-Source Computed Tomography Imaging in Coronary Bypass Surgery

2011 ◽  
Vol 14 (5) ◽  
pp. 283 ◽  
Author(s):  
Andre Plass ◽  
Maximilian Y. Emmert ◽  
Oliver Gaemperli ◽  
Hatem Alkadhi ◽  
Philipp Kaufmann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Predictive Value ◽  
Bypass Surgery ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct

<p><b>Background:</b> We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone.</p><p><b>Methods:</b> After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 � 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed.</p><p><b>Results:</b> CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect).</p><p><b>Conclusions:</b> Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.</p>

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