Impact of transmurality and location on the diagnostic performance of 13N-ammonia positron emission tomography in the detection of myocardial fibrosis - A hybrid positron emission tomography/magnetic resonance study.
Pascal S Heiniger, Gian Diego Igual, Andrei Galafton, Tobia Albertini, Marko Gajic, Stjepan Jurisic, Rita Pingree, Dominik C Benz, Aju P Pazhenkottil, Andreas A Giannopoulos, Philipp A Kaufmann, Ronny R Buechel
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Abstract
Background: The influence of fibrosis transmurality and location on the diagnostic performance of positron emission tomography (PET) myocardial perfusion imaging (MPI) for detecting myocardial fibrosis remains unclear.
Methods and results: One hundred patients with suspected or known coronary artery disease (n = 50) or with a history of myocarditis (n = 50) underwent simultaneous cardiac magnetic resonance (CMR) and 13N-ammonia PET imaging on a hybrid positron emission tomography/magnetic resonance (PET/MR) device. CMR served as the reference with late gadolinium enhancement defining fibrosis of the left ventricular myocardium. PET MPI was assessed for fibrosis qualitatively (i.e. visually), semiquantitatively, and quantitatively (both threshold-based). From CMR, for every segment, the transmurality and location (subendocardial, midmyocardial, or subepicardial) of fibrosis were recorded. The sensitivity and specificity of qualitatively analyzed PET to detect fibrosis were 83.6% and 84.9% per patient and 52.9% and 96.4% per segment, respectively, outperforming the threshold-based semiquantitative and quantitative analyses. On a per-segment basis, the sensitivity of PET was increasing with transmurality and was dependent on location with higher sensitivities for subendocardial than subepicardial or midmyocardial fibrosis (P < .001). Overall median fibrosis extent, as depicted by PET, was significantly smaller than by CMR (2.0 [IQR 1.0-5.0] vs 3.0 [IQR 2.0-6.0] segments, P < .001).
Conclusions: PET yields high sensitivity for the detection of left ventricular (LV) myocardial fibrosis of ischemic or inflammatory etiology on a per-patient basis. However, compared to CMR, the overall fibrosis extent is significantly underestimated because, on a segmental level, sensitivities are significantly lower for fibrosis with lower transmurality and those located subepicardial and midmyocardial, as compared to subendocardial.
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Journal of Nuclear Cardiology is the only journal in the world devoted to this dynamic and growing subspecialty. Physicians and technologists value the Journal not only for its peer-reviewed articles, but also for its timely discussions about the current and future role of nuclear cardiology. Original articles address all aspects of nuclear cardiology, including interpretation, diagnosis, imaging equipment, and use of radiopharmaceuticals. As the official publication of the American Society of Nuclear Cardiology, the Journal also brings readers the latest information emerging from the Society''s task forces and publishes guidelines and position papers as they are adopted.
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