FDG-PET/CT and PET/MR in Cardiovascular Diseases

Preface
Contents
Part I: Instrumentation and Metabolism
	1: Cardiac Positron Emission Tomography Basics
		Introduction
		Basic Radiation Physics in PET Imaging
			Radioactive Decay by Positron Emission and Electron Capture
			The Positron Annihilation Process
			Important Isotopes Used in PET Imaging
		Radiation Detection and PET Detector Systems
			Scintillation Detectors
			Photomultiplier Tubes (PMTs)
			The PET Camera
				Data Acquisition, Projections, and Sinograms
		Correction for Physical Effects and Image Reconstruction
			Correction for Scatter Coincident Events
			Correction for Random Coincident Events
			Correction for Cascade Gamma Coincident Events
			Correction for Detector Dead Time and Pulse Pile-Up
			Correction for Photon Attenuation
			Intrinsic and Reconstructed Spatial Resolution
		Image Reconstruction from Projections
			Filtered Back-Projection
			Iterative Reconstruction
		References
	2: Cardiac PET/MR Basics
		Introduction
		PET/MR Instrumentation
		Attenuation Correction
		Motion Correction
		Radiation Dose Reduction
		Cardiac MRI
		References
	3: Review of Cardiac Metabolism and FDG
		Introduction
		Cardiac Metabolism in Health
			The Basics of Cardiac Metabolism: Free Fatty Acids, Glucose, Ketones
				FFA Metabolism in Myocardium
				Glucose Metabolism in Myocardium
				Ketone Metabolism in Myocardium
		Cardiac Metabolism in Disease
			Cardiac Metabolism and Aging
			Cardiac Metabolism and Heart Failure
			Cardiac Metabolism in Obesity and Diabetes
			Cardiac Metabolism in Ischemia
		Conclusion
		References
	4: Myocardial Suppression Protocols
		Introduction
		Underlying Physiology of Myocardial and Inflammatory Cell Glucose Metabolism
		Goals of Preparation for 18F-FDG-PET Imaging
		Patterns of Myocardial 18F-FDG Uptake
		Approaches to Suppress Myocardial 18F-FDG Uptake
			Dietary Strategies
				Prolonged Fasting
				High-Fat Low-Carbohydrate Diet
				High-Fat Drink
			Behavioral Strategies
			Pharmacologic Strategies
				Heparin
				Calcium Channel Blockers
			Communication
			Combination Strategies
		Laboratory Values
		Patient Populations Requiring Special Considerations
		Current Recommendations
		Future Directions
		References
Part II: Inflammatory and Malignant Disorders
	5: Cardiac Sarcoidosis
		Introduction
		Histopathology
		Epidemiology
			Rates of Cardiac Involvement
		Clinical Presentation and Prognosis
		Diagnostic Workup
			Serum Biomarkers
			Endomyocardial Biopsy
			ECG Findings
			Echocardiography
			Cardiac Magnetic Resonance (CMR)
		FDG-PET Imaging of Patients with CS
			Protocols for Cardiac FDG-PET Imaging
			Interpretation Criteria
			Diagnostic Accuracy of FDG-PET for the Assessment of CS
			Prognostic Significance
			Role in Assessing Response
			FDG-PET/MR for the Assessment of CS
			Comparison of FDG-PET/CT to MRI
		Future Directions
		Conclusion
		References
	6: Myocarditis
		Introduction
			Epidemiology
			Clinical Presentation
		Myocarditis Classification
			Lymphocytic Viral Myocarditis
			Giant Cell Myocarditis
			Cardiac Sarcoidosis
			Eosinophilic Cardiomyopathy
		Diagnosis and Investigation
			Endomyocardial Biopsy
			Echocardiography
			Cardiac Magnetic Resonance (CMR)
				Lake Louise Criteria
			Positron Emission Tomography
		PET/MR
			Imaging Protocol and Interpretation
		Conclusion
		References
	7: Large Vessel Vasculitis
		Introduction
		FDG-PET Procedure
			Patient Preparation
			PET Acquisition Procedure
		Interpretation and Reporting of FDG-PET/CT
			Visual Grading Scales
				Cranial Artery Assessment
			Quantification
			Diagnostic Performance
			Monitoring and Follow-Up
			PET Combined with CTA or MRA
			Potential Pitfalls in LVV FDG-PET Imaging
		Perspectives in LVV Imaging
		References
	8: Pericardial Diseases
		Introduction
		Infectious Pericardial Diseases
		Autoimmune Pericardial Diseases
		Neoplastic Pericardial Diseases
		Other Non-Infectious Pericardial Diseases
		Conclusion
		References
	9: Ventricular Arrhythmias
		Introduction
		Mechanistic Bases
		General Principles of 18F-FDG PET/CT Imaging in the Setting of Ventricular Arrhythmias
		Cardiac Sarcoidosis
		Ventricular Arrhythmias of Unknown Etiology
		Conclusion
		References
	10: Cardiac Tumors
		Introduction
		Primary Cardiac and Pericardiac Lesions
			Epidemiology of Primary Cardiac Lesions
			Types of Primary Cardiac and Pericardiac Masses
			Symptoms and Clinical Presentation
			Diagnostic Approach
		Benign Cardiac Lesions
			Intra-Cardiac Thrombi
			Vegetations
			Calcified Amorphous Tumors
			Cardiac Myxoma
			Papillary Fibroelastoma
			Lipoma
			Rhabdomyoma
			Fibroma
			Hemangioma
		Tumors of Uncertain Biological Behavior
			Cardiac Paraganglioma
		Germ Cell Tumors
		Malignant Cardiac Lesions
			Cardiac Angiosarcoma
			Leiomyosarcoma
			Rhabdomyosarcoma
			Primary Cardiac Lymphoma
		Secondary Cardiac Masses
			Epidemiology of Secondary Cardiac Lesions
			Sources of Secondary Cardiac Masses
			Secondary Cardiac Lymphoma
		Miscellaneous Cardiac Lesions
			Lipomatous Hypertrophy of the Interatrial Septum
		Mechanisms of Spread to the Heart and Pericardium
			Cardiac Lymphatic Anatomy
		Roles of FDG-PET Imaging of Cardiac Masses
			Cardiac Metabolism and Patient Preparation for Cardiac FDG-PET
			FDG-PET/CT
			FDG-PET/MRI
		Conclusion
		References
	11: Fibrosing Mediastinitis
		Fibrosing Mediastinitis
		References
Part III: Cardiovascular Infections
	12: Prosthetic Valve Endocarditis
		Epidemiology, Microbiology, and Pathophysiology of PVE
			Diagnostic Workout
			FDG PET/CT and PET/MR Imaging
		Specific Technical Considerations
			Patient Preparation
			Radiopharmaceutical: Administered Activity
			Concomitant Treatments
			Other Special Considerations
			Image Acquisition Protocol and Postprocessing
			Image Reconstruction
			Image Quality Assessment
			Image Analysis and Interpretation Criteria
			Overall Clinical Performance
			Extra-Cardiac Manifestations
			Multidisciplinary Discussion of Imaging Results
		Conclusion
		References
	13: Native-Valve Endocarditis
		Introduction
		Pathophysiology
		Epidemiology
		Clinical Presentation and Diagnosis
		Management
		FDG-PET/CT Imaging
		Extracardiac Manifestations of Infective Endocarditis
		Prognostic Value
		Conclusion
		References
	14: Cardiovascular Implantable Electronic Device Infection
		Introduction
			Cardiac Implantable Electronic Device (CIED) Infections
			Left Ventricular Assist Device (LVAD) Infection
		Diagnostic Work-Up of CIED and LVAD Infections
			Clinical Signs
			Microbiology
			Imaging
			Echocardiography
			Cardiac CT
			Endocarditis Team
			Prognosis
		FDG PET/CT
			Basic Principles
			Patient Preparation
			Tracer Administration
			Imaging Procedure
			Interpretation Criteria
		CIED Infections
		LVAD Infections
		Comparison with WBC SPECT/CT
		Perspectives
		Conclusions
		References
	15: Vascular Graft Infection
		Introduction
		Frequency, Pathogenesis, and Clinical Presentation
		Diagnosis of VGI
			Ultrasonography (US)
			Computed Tomography Angiography (CTA)
			Magnetic Resonance Angiography (MRA)
			Radiolabeled White Blood Cell (WBC) Scintigraphy
		FDG PET/CT in VGI
			PET/CT Acquisition Protocol
			Interpretation Criteria/Methods
			Limitations and Pitfalls
			Monitoring Therapy
		Conclusion
		References
	16: Left Ventricular Assist Device Infection
		Epidemiology
		Pathophysiology
			VAD-Specific Infection: Percutaneous Driveline Infections
			VAD-Specific Infection: Pump Pocket and Cannula Infections
			VAD-Related Infections
			Microbiology
		Treatment
		Diagnostic Strategies
		Factors That Affect Image Quality and Interpretation
			Preparation and Image Acquisition
			Interpretation and Reporting
		Clinical Cases
		Conclusion
		References
	17: Sternal Wound Infection and Mediastinitis
		Introduction
		Epidemiology
		Pathogenesis
		Treatments
		Clinical Presentation
		Computed Tomography
		Magnetic Resonance Imaging
		Positron Emission Tomography
			Imaging Protocol
			Image Interpretation
		Conclusion
		References
Part IV: Atherosclerotic Disease
	18: Atherosclerosis Imaging
		Introduction
		Atherosclerotic Plaque Biology
		Inflammation in Atherosclerosis
		Noninvasive Molecular Imaging of Atherosclerosis Inflammation with 18F-FDG
		Impact of Therapies on Atherosclerosis Inflammation Measured with 18F-FDG
		Molecular Imaging of Coronary Inflammation
		Microcalcification Activity and Other Targets for Molecular Imaging of Atherosclerotic Plaque
		Hybrid PET/Magnetic Resonance Imaging (MRI) Systems
		Multimodality Molecular Imaging Approaches
		Clinical Applications
		Conclusion
		References
	19: Coronary Artery Disease
		Introduction
		18F-Fluorodeoxyglucose (FDG) Imaging of Metabolic Activity
			FDG Imaging for CAD Detection and Risk Prediction
			Limitations of FDG Imaging in Coronary Atherosclerosis
			Standardizing FDG Protocols for Improved Imaging of Coronary Atherosclerosis
		18F-NaF Imaging of Microcalcification
			Clinical Utility of NaF in Coronary Atherosclerotic Imaging
			NaF Imaging in Prospective Risk Assessment
			Limitations and Future Directions
		68Ga-Pentixafor Imaging of CXCR4 Inflammation
			The CXCR4 Signaling Pathway
			Nuclear Imaging of CXCR4 in Coronary Atherosclerosis
			Comparison of 18F-FDG and 68Ga-Pentixafor Imaging
			Clinical Applications of  CXCR4-Targeted Imaging
		Emerging Tracers
		References
	20: Viability Imaging
		Introduction
		Viability: Back to Basics: Understanding the Terminology
		Clinical Applications for Viability
		Nuclear Methods for Assessing Viability
			SPECT
				99mTc-labelled agents
				Thallium-201
			PET
				FDG PET Imaging Protocols
				Image Interpretation of FDG
		Cardiovascular Magnetic Resonance Imaging Methods for Assessing Viability
			End Diastolic Wall Thickness To Predict Functional Recovery
			Dobutamine CMR for Assessment of Contractile Reserve to Predict Functional Recovery
			Transmural Extent of Scar by LGE Imaging to Predict Functional Recovery
			Future Prospects for Metabolic and Hybrid CMR to Predict Functional Recovery
		Evidence for the Role of Viability Imaging
		Future Directions
		Conclusion
		References
Part V: FDG-PET in Special Populations
	21: Pediatrics Cardiovascular FDG-PET Imaging
		Introduction
		Minimization of Radiation Exposure
			Eliminating Unnecessary Examinations
			Reducing Radiotracer Dose
			Optimizing CT Imaging Parameters and Reducing Scan Range
		18F-FDG PET/CT Protocols
			Typical 18F-FDG PET/CT Imaging Session
			Myocardial Viability
			Myocardial Suppression
		18F-FDG PET/CT and Pediatric Sedation
		Pediatric 18F-FDG PET/MR Cardiovascular Imaging
		Kawasaki Disease
		Anomalous Coronaries
		Congenital Heart Disease
			Transposition of the Great Arteries
			Single Ventricle and Hypoplastic Left Heart Syndrome
			Modified Blalock–Taussig Shunt
			Bidirectional Glenn (Cavobipulmonary) Shunt
			Norwood Staged Procedures
			Jatene Arterial Switch Procedure
			Right Ventricle–Pulmonary Artery (RV-PA) Conduit
			Tetralogy of Fallot
		Cardiovascular Infections
			Infections Related to Sternotomy
			Congenital Heart Disease Repair
			Fever of Unknown Origin
			Ventricular Assist Devices
			Cardiac Implantable Electronic Devices
		Pericardial Disease
		Conclusion
		References
	22: FDG-PET/CT in Heart Transplant
		Introduction
		Pretransplant Screening
		Posttransplantation Graft-Related Complications
		Posttransplantation Non–Graft-Related Complications
			Infections
			Malignancies
		Role of FDG-PET/CT in Detection, Staging, and Response Assessment of PTLD
			Role of FDG-PET/CT in Detection and Staging of PTLD
			Role of FDG-PET/CT in Response Assessment of PTLD
			Prognostic Role of Baseline FDG PET/CT in PTLD
		Conclusion
		References
Part VI: Variants and Cases
	23: Normal Variants, Not-So-Normal Variants, and Pitfalls of FDG-PET in Cardiovascular Imaging
		Introduction
		Patterns of Myocardial Uptake
			Left Ventricular Uptake
			Right Ventricular Uptake
			Atrial Uptake
		Pitfalls
		Conclusion
		References
	24: Cardiovascular FDG-PET Atlas of Cases
		Case 1
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 2
			Initial Evaluation
			Teaching Point
		Case 3
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 4
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 5
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 6
			Initial Evaluation
			Follow-Up (1)
			Follow-Up (2)
			Follow-Up (3)
			Teaching Point
		Case 7
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 8
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 9
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 10
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 11
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 12
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 13
			Initial Evaluation
			Follow-Up (1)
			Follow-Up (2)
			Follow-Up (3)
			Teaching Point
		Case 14
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 15
			Initial Evaluation
			Follow-Up (1)
			Follow-Up (2)
			Teaching Point
		Case 16
			Initial Evaluation
			Follow-Up
			Teaching Point
		Case 17
			Initial Evaluation
			Follow-Up
			Teaching Point
		References
Index