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18F-sodium fluoride positron emission tomography-magnetic resonance in valvular and coronary artery disease; a validation study with positron emission tomography-computerised tomograph

Session Abstract session 4: latest advances in CMR technology and safety

Speaker Jack Andrews

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Hybrid and Fusion Imaging
  • Session type : Abstract Session

Authors : J Andrews (Edinburgh,GB), G Macnaught (Edinburgh,GB), P Robson (New York,US), A Moss (Edinburgh,GB), M Doris (Edinburgh,GB), T Pawade (Edinburgh,GB), P Adamson (Edinburgh,GB), Z Fayad (New York,US), C Lucatelli (Edinburgh,GB), DE Newby (Edinburgh,GB), M Dweck (Edinburgh,GB)

Authors:
J Andrews1 , G Macnaught1 , P Robson2 , A Moss1 , M Doris1 , T Pawade1 , P Adamson1 , Z Fayad2 , C Lucatelli1 , DE Newby1 , M Dweck1 , 1University of Edinburgh, Cardiology - Edinburgh - United Kingdom of Great Britain & Northern Ireland , 2Mount Sinai School of Medicine - New York - United States of America ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii426

Objectives and background
18F-Fluoride PET can be used to investigate calcification activity in aortic atheroma, coronary artery disease and aortic stenosis with major clinical potential. While PET-MR has advantages over PET-CT, including tissue characterisation and reduced radiation exposure and motion correction, the two modalities have not been directly compared for cardiovascular application. 

Methods
11 patients with a recent myocardial infarction and 7 with mild/moderate aortic stenosis underwent 18F-Fluoride cardiac PET-CT followed immediately by cardiac PET-MR. Uptake was evaluated semi-quantitatively by an expert reader over the aortic valve, ascending aorta, coronary arteries and areas of myocardial infarction. A novel free-breathing MR-based attenuation correction was compared against the standard Dixon breath-held approach, and both maps validated against PET-CT. Results were expressed in standardised uptake values (SUV) and tissue-to-background ratios (TBR’s).

Results
The pattern of uptake on the aortic valve and ascending aorta was visually similar between PET-CT and both PET-MR AC techniques. Coronary uptake, clearly appreciated on PET-CT was not always easily identified on free breathing PET-MR. This appeared to be due to PET dropout secondary to metallic stents (figure 1). Employing standard breath-held PET-MR corrected this problem. Overall, image quality was significantly improved by novel free-breathing attenuation correction and fluoride uptake in areas of LGE were greater than that of remote healthy myocardium on both PET-MR and PET-CT scans.

Conclusion
The results of this study validate PET-MR as a reliable method of imaging microcalcification activity on the aortic valve, aorta, coronary arteries and myocardium. The novel free-breathing PET-MR AC map improves image quality but is susceptible to PET dropout in stented arteries. Further work on tissue classification for implanted metallic material is now needed to refine this promising technique.

PET CT

PET-MR (free- breathing)

PET-MR (breath-held)

PET-CT vs PET-MR (free-breathing)

p value

PET-CT vs PET-MR (breath-held)

p value

PET-MR (free-breathing vs breath-held) p value

Aortic valve TBRmax

1.55±0.33

1.58±0.34

1.38±0.44

0.89

0.05

0.02

Ascending Aorta TBRmax

1.46±0.20

1.49±0.28

1.35±0.31

0.81

0.25

0.006

Culprit coronary TBRmax

1.33±0.4

1.06±0.24

1.14±0.43

0.3

0.49

0.89

Hot coronary plaque TBRmax

1.12±0.24

1.17±0.26

1.08±0.28

0.45

0.58

0.02

Scar TBRmean

0.78±0.18

0.71±0.11

0.64±0.9

0.51

0.07

0.57

TBR comparison between hybrid imaging modalities and attenuation correction maps across the aortic valve, ascending aorta, coronary arteries and myocardium can be seen in table 1. Results expressed as mean +/- standard deviation.


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