OJMI  Vol.2 No.2 , June 2012
Clinical Utility of N-13 Ammonia Cardiac PET Perfusion Imaging in the Assessment of Epicardial Coronary Lesions of Intermediate Range
ABSTRACT
Objective: To identify the high risk myocardial perfusion defects which prognosticate the future ischemic cardiac events, on Positron emission tomography (PET) myocardial perfusion imaging (MPI) of intermediate coronary stenosis (ICS) on coronary angiogram (CAG) with negative single photon emission computed tomography (SPECT) MPI in chronic stable angina (CSA) patients. Methods: For this study non-infarcted CSA patients of single vessel disease (SVD) on CAG with ICS and normal LV function were selected. In all patients with negative stress SPECT MPI, stress PET MPI was done. In both scans, extent score (ES), severity score (SS), total severity/extent score ratio (TS-ES R) and Left ventricular dilatation (LVD) were noted. Patients with Positive PET MPI were closely followed for 2yrs and PCI was performed depending on symptoms. Results: Out of 47 study group patients, during 2yr follow up period, 11 out of 15 patients with ischemia positive PET MPI underwent percutaneous coronary intervention (PCI). Indication for PCI was rest or persistence or recurrence of angina. Four of 15 patients remained asymptomatic. In medically managed vs. PCI done patients, mean of ES was 1.2 ± 0.5 vs. 2.3 ± 1, SS was 1.2 ± 0.5 vs. 5.3 ± 1.9, TS-ESR was 1 vs. 2.5 ± 0.5 which was statistically significant (p = 0.01). Conclusion: It was inferred that subgroup of PET MPI positive ICS patients with basal PET MPI showing SS > 5 and TS-ES R > 1.5 with LVD during stress required close follow up as they are likely require PCI subsequently. Condensed Abstract: As negative for inducible ischemia by single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is associated with low cardiac event rate, even though positive imaging by Positron emission tomography myocardial perfusion imaging (PET MPI), in patients with intermediate Coronary stenosis (ICS) may not require immediate percutaneous coronary intervention (PCI). We fol-lowed these patients for two 2yrs and identified that basal PET MPI showing total severity score > 5 and total severity/ extent score ratio > 1.5 with Left ventricular dilatation during stress required PCI subsequently.

Cite this paper
M. Jyotsna, G. Somasekhar, V. Rao, R. Kumar and E. Jyotsna, "Clinical Utility of N-13 Ammonia Cardiac PET Perfusion Imaging in the Assessment of Epicardial Coronary Lesions of Intermediate Range," Open Journal of Medical Imaging, Vol. 2 No. 2, 2012, pp. 41-46. doi: 10.4236/ojmi.2012.22007.
References
[1]   F. Zijlstra, P. Fioretti, J. H. C. Reiber, et al., “Which Cineangiographically Assessed Anatomic Variable Correlates Best with Functional Measurements of Stenosis Severity? A Comparison of Quantitative Analysis of the Coronary Cineangiogram with Measured Coronary Flow Reserve and Exercise/Redistribution Thallium-201 Scintigraphy,” Journal of the American College of Cardiology, Vol. 12, No. 3, 1988, pp. 686-691.

[2]   J. H. O’Keefe Jr., C. S. Barnhart and T. M. Bateman, “Comparison of Stress Echocardiography and Stress Myocardial Perfusion Scintigraphy for Diagnosing Coronary Artery Disease and Assessing Its Severity,” The American Journal of Cardiology, Vol. 75, No. 11, 1995, pp. 25D-34D.

[3]   D. S. Berman, G. Germano and L. J. Shaw. “The Role of Nuclear Cardiology in Clinical Decision Making,” Seminars in Nuclear Medicine, Vol. 29, No. 4, 1999, pp. 280297. doi:10.1016/S0001-2998(99)80017-8

[4]   L. D. Metz, M. Beattie, R. Hom, R. F. Redberg, D. Grady and K. E. Fleischmann. “The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography: A Meta-Analysis,” Journal of the American College of Cardiology, Vol. 49, No. 2, 2007, pp. 227-237. doi:10.1016/j.jacc.2006.08.048

[5]   T. H. Schindler, H. R. Schelbert, A. Quercioli and V. Dilsizian, “Cardiac PET Imaging for the Detection and Monitoring of Coronary Artery Disease and Microvascular Health,” JACC: Cardiovascular Imaging, Vol. 3, No. 6, 2010, pp. 623-640. doi:10.1016/j.jcmg.2010.04.007

[6]   R. T. Go, T. H. Marwick, W. J. MacIntyre, et al., “A Prospective Comparison of Rubidium-82 PET and Thallium-201 SPECT Myocardial Perfusion Imaging Utilizing a Single Dipyridamole Stress in the Diagnosis of Coronary Artery Disease,” Journal of Nuclear Medicine, Vol. 31, No. 12, 1990, pp. 1899-1905.

[7]   R. E. Stewart, M. Schwaiger, E. Molina, et al., “Comparison of Rubidium-82 Positron Emission Tomography and Thallium-201 SPECT Imaging for Detection of Coronary Artery Disease,” The American Journal of Cardiology, Vol. 67, No. 16, 1991, pp. 1303-1310. doi:10.1016/0002-9149(91)90456-U

[8]   T. M. Bateman, G. V. Heller, A. I. McGhie, et al., “Diagnostic Accuracy of Rest/Stress ECG-Gated Rb-82 Myocardial Perfusion PET: Comparison with ECG-Gated Tc-99m Sestamibi SPECT,” Journal of Nuclear Cardiology, Vol. 13, No. 1, 2006, pp. 24-33. doi:10.1016/j.nuclcard.2005.12.004

[9]   J. Heo, J. Kegel, A. S. Iskandrrian, et al., “Comparision of Same Day Protocols Using Tc 99m Sestamibi Myocardial Imaging,” Journal of Nuclear Medicine, Vol. 33, No. 2, 1992, pp. 186-191.

[10]   M. U. Zaman, I. Hashmi and N. Fatima, “Recent Developments and Future Prospects of SPECT Myocardial Perfusion Imaging,” Annals of Nuclear Medicine, Vol. 24, No. 8, 2010, pp. 565-569.

[11]   M. Naya and M. F. Di Carli, “Myocardial Perfusion PET/CT to Evaluate Known and Suspected Coronary Artery Disease,” The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Vol. 54, No. 2, 2010, pp. 145-156.

[12]   G. D. Hutchins, M. Schwaiger, K. C. Rosenspire, J. Krivokapich, H. Schelbert and D. E. Kuhl, “Noninvasive Quantification of Regional Blood Flow in the Human Heart Using N-13 Ammonia and Dynamic Positron Emission Tomographic Imaging,” Journal of the American College of Cardiology, Vol. 15, No. 5, 1990, pp. 10321042. doi:10.1016/0735-1097(90)90237-J

[13]   N. Tamaki, T. D. Ruddy and R. Dekamp, “Myocardial Perfusion,” In: R. L. Wahl and J. W. Buchanan, Ed., Principles and Practice of Positron Emission Tomography, Lippincott Williams & Wilkins, Philadelphia, 2002, pp. 320-333.

[14]   K. Yoshinaga, B. J. Chow, K. Williams, et al., “What is the Prognostic Value of Myocardial Perfusion Imaging Using Rubidium-82 Positron Emission Tomography?” Journal of the American College of Cardiology, Vol. 48, No. 5, 2006, pp. 1029-1039.

[15]   S. Dorbala, R. Hachamovitch, R. Kwong, Z. Curillova and M. F. Di Carli, “Incremental Prognostic Value of Rubidium-82 Myocardial Perfusion PET-CT Imaging in Patients with Known or Suspected CAD,” Journal of the American College of Cardiology, Vol. 49, 2007, p. 109.

 
 
Top