Yonsei Med J.  2010 Mar;51(2):178-186. 10.3349/ymj.2010.51.2.178.

Diagnosis of Myocardial Viability by Fluorodeoxyglucose Distribution at the Border Zone of a Low Uptake Region

• Toyota E
• Sone T
• Yoshikawa
• Mimura H
• Hayashida
• Wada N
• Obase K
• Imai K
• Saito K
• Maehama T
• Fukunaga M
• Yoshida K

• KMID: 1126015
• DOI: http://doi.org/10.3349/ymj.2010.51.2.178

Abstract

PURPOSE: In cardiac 2-[F-18]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) examination, interpretation of myocardial viability in the low uptake region (LUR) has been difficult without additional perfusion imaging. We evaluated distribution patterns of FDG at the border zone of the LUR in the cardiac FDG-PET and established a novel parameter for diagnosing myocardial viability and for discriminating the LUR of normal variants.
MATERIALS AND METHODS
Cardiac FDG-PET was performed in patients with a myocardial ischemic event (n = 22) and in healthy volunteers (n = 22). Whether the myocardium was not a viable myocardium (not-VM) or an ischemic but viable myocardium (isch-VM) was defined by an echocardiogram under a low dose of dobutamine infusion as the gold standard. FDG images were displayed as gray scaled-bull's eye mappings. FDG-plot profiles for LUR (= true ischemic region in the patients or normal variant region in healthy subjects) were calculated. Maximal values of FDG change at the LUR border zone (a steepness index; S(max) scale/pixel) were compared among not-VM, isch-VM, and normal myocardium.
RESULTS
S(max) was significantly higher for n-VM compared to those with isch-VM or normal myocardium (ANOVA). A cut-off value of 0.30 in Smax demonstrated 100% sensitivity and 83% specificity for diagnosing n-VM and isch-VM. S(max) less than 0.23 discriminated LUR in normal myocardium from the LUR in patients with both n-VM and isch-VM with a 94% sensitivity and a 93% specificity.
CONCLUSION
S(max) of the LUR in cardiac FDG-PET is a simple and useful parameter to diagnose n-VM and isch-VM, as well as to discriminate thr LUR of normal variants.

Keyword

Fluorodeoxyglucose; myocardial infarction; organ viability; image processing; echocardiography

MeSH Terms

Aged
Aged, 80 and over
Echocardiography
Female
Fluorodeoxyglucose F18/*metabolism
Humans
Male
Middle Aged
Myocardial Infarction/metabolism/pathology
Myocardium/*metabolism/*pathology
Positron-Emission Tomography
Young Adult

Figure

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  Fig. 1 Representative images of cardiac FDG-PET and Smax in patients with myocardial ischemic event as well as healthy volunteers. Myocardium in patient #17 was defined as viable by an echocardiogram under low dose of dobutamine stress. Myocardium in patient #15 and #20 were defined as not viable. (A) FDG bull's eye mapping (colored and gray scaled). Low uptake regions were observed in both patients (#17, #15, and #20) and healthy volunteers (#20 and #16). (B) FDG plot profile along white and blue lines in the panel A. (C) Changing rate of FDG gray scale per pixel along the line. Absolute values (red) indicate Smax values. The pink dots in the panels A, B, and C indicate the location of Smax. (D) Hmax/Lmax values are shown. FDG, cardiac 2-[F-18] fluoro-2-deoxy-D-glucose; PET, positron emission tomegraphy.

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  Fig. 2 Difference of Smax in three myocardial conditions. The Smax is the highest in the not viable myocardium (red circles), intermediate in ischemic but viable myocardium (brown circles), and the lowest in normal myocardium (blue circles). Closed circles and solid lines (mean ± SD): data from the subjects with Hmax/Lmax ≥10. Open circles: data of the subjects with Hmax/Lmax < 10. Dashed lines (mean ± SD) were analyzed by including all data (both Hmax/Lmax≥10 and <10).

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  Fig. 3 Inter-observer variability of Smax values.

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  Fig. 4 Schematic diagram of real FDG uptake in the myocardial wall and FDG-PET count. Gray area: positive FDG uptake. White area: negative FDG uptake. Voxel size of the PET scanner in the present study was 3.3×3.3×3.3 mm3. FDG count is displayed as its average of that in the transmural wall. Steepness of the FDG slope at the border zone of the low uptake region is different for not viable myocardium, ischemic but viable myocardium, and normal variant (speculated). FDG, cardiac 2-[F-18] fluoro-2-deoxy-D-glucose; PET, positron emission tomegraphy.

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  Fig. 5 Diagram of strategy to diagnose myocardial viability and discrimination of normal variant.

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