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Oliver S, Moliner L, Ilisie V, Benlloch J, Rodríguez-Álvarez M. Simulation Study for Designing a Dedicated Cardiac TOF-PET System. SENSORS 2020; 20:s20051311. [PMID: 32121227 PMCID: PMC7085583 DOI: 10.3390/s20051311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Abstract
The development of dedicated positron emission tomography scanners is an active area of research, especially aiming at the improvement of lesion detection and in support of cancer treatment and management. Recently, dedicated Positron Emission Tomography (PET) systems with different configurations for specific organs have been developed for improving detection effectiveness. Open geometries are always subject to distortion and artifacts in the reconstructed images. Therefore, the aim of this work is to determine the optimal geometry for a novel cardiac PET system that will be developed by our team, and determine the time resolution needed to achieve reasonable image quality for the chosen geometry. The proposed geometries consist of 36 modules. These modules are arranged in two sets of two plates, each one with different configurations. We performed Monte Carlo simulations with different TOF resolutions, in order to test the image quality improvement in each case. Our results show, as expected, that increasing TOF resolution reduces distortion and artifact effects. We can conclude that a TOF resolution of the order of 200 ps is needed to reduce the artifacts, to acceptable levels, generated in the simulated cardiac-PET open geometries.
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Mendoza-Pinto C, Rojas-Villarraga A, Molano-González N, García-Carrasco M, Munguía-Realpozo P, Etchegaray-Morales I, Morales-Sánchez H, Berra-Romani R, Cervera R. Endothelial dysfunction and arterial stiffness in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Atherosclerosis 2020; 297:55-63. [PMID: 32078830 DOI: 10.1016/j.atherosclerosis.2020.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Non-invasive surrogates of cardiovascular (CV) disease such as endothelial dysfunction (ED) and peripheral arterial stiffness (AS) have been evaluated in systemic lupus erythematosus (SLE) patients. The aim of this study was to systematically review and meta-analyze reports of cardiovascular disease (CVD) in SLE patients, as measured by ED and AS. METHODS Studies analyzing the relationship of SLE with ED (flow-mediated dilatation [FMD], nitroglycerin-mediated dilatation [NMD] and peripheral arterial tonometry [PAT]) and AS (augmentation index [AIx], pulse wave velocity [PWV]) were systematically searched for in PubMed, Cochrane library, EMBASE, VHL, SciELO and Web of Science databases. Inclusion criteria included peer-review and English language. Mean differences (MD) and 95% confidence intervals (CIs) were estimated using the random effect model. The study was registered with PROSPERO, number CRD42019121068. RESULTS The meta-analysis included 49 studies. FMD data from 18 studies including 943 SLE subjects (mean age = 38.71 [95%CI 36.21, 41.21] years) and 644 unaffected controls (mean age = 38.63 [95%CI 36.11, 41.15] years) were included. When compared with unaffected controls, FMD in SLE subjects was decreased by 4.3% (95%CI: -6.13%, -2.47%): p < 0.001). However, NMD did not significantly differ between SLE patients and controls (MD = - 2.68%; 95% CI -6.00, 0.62; p = 0.11). A significantly increased AS between SLE patients and controls according to overall PWV (MD = 1.12 m/s; 95% CI 0.72-1.52; p < 0.001) was observed, but not for the brachial-ankle PWV. AIx was also increased in SLE patients compared with healthy controls (MD = 4.55%; 95% CI 1.48-7.63; p = 0.003). CONCLUSIONS Overall, SLE patients showed impaired FMD, an independent predictor of CV events. There was a higher degree of AS in SLE patients compared with controls. ED and AS in SLE should be considered when planning preventive strategies and therapies.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | - Nicolás Molano-González
- Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, High Specialized Medical Unit, UMAE CMNMAC - CIBIOR, Mexican Social Security Institute, Puebla, Mexico; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Héctor Morales-Sánchez
- Department of Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Roberto Berra-Romani
- Department of Biomedicine, School of Medicine, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
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Santos BS, Ferreira MJ. Positron emission tomography in ischemic heart disease. Rev Port Cardiol 2019; 38:599-608. [DOI: 10.1016/j.repc.2019.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/03/2019] [Indexed: 01/30/2023] Open
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Santos BS, Ferreira MJ. Positron emission tomography in ischemic heart disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Alessio AM, Bindschadler M, Busey JM, Shuman WP, Caldwell JH, Branch KR. Accuracy of Myocardial Blood Flow Estimation From Dynamic Contrast-Enhanced Cardiac CT Compared With PET. Circ Cardiovasc Imaging 2019; 12:e008323. [PMID: 31195817 DOI: 10.1161/circimaging.118.008323] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The accuracy of absolute myocardial blood flow (MBF) from dynamic contrast-enhanced cardiac computed tomography acquisitions has not been fully characterized. We evaluate computed tomography (CT) compared with rubidium-82 positron emission tomography (PET) MBF estimates in a high-risk population. Methods In a prospective trial, patients receiving clinically indicated rubidium-82 PET exams were recruited to receive a dynamic contrast-enhanced cardiac computed tomography exam. The CT protocol included a rest and stress dynamic portion each acquiring 12 to 18 cardiac-gated frames. The global MBF was estimated from the PET and CT exam. Results Thirty-four patients referred for cardiac rest-stress PET were recruited. Of the 68 dynamic contrast-enhanced cardiac computed tomography scans, 5 were excluded because of injection errors or mismatched hemodynamics. The CT-derived global MBF was highly correlated with the PET MBF (r=0.92; P<0.001) with a mean difference of 0.7±26.4%. The CT MBF estimates were within 20% of PET estimates ( P<0.02) with a mean of (1) MBF for resting flow of PET versus CT of 0.9±0.3 versus 1.0±0.2 mL/min per gram and (2) MBF for stress flow of 2.1±0.7 versus 2.0±0.8 mL/min per gram. Myocardial flow reserve was -14±28% underestimated with CT (PET versus CT myocardial flow reserve, 2.5±0.6 versus 2.2±0.6). The proposed rest+stress+computed tomography angiography protocol had a dose length product of 598±76 mGy×cm resulting in an approximate effective dose of 8.4±1.1 mSv. Conclusions In a high-risk clinical population, a clinically practical dynamic contrast-enhanced cardiac computed tomography provided unbiased MBF estimates within 20% of rubidium-82 PET. Although unbiased, the CT estimates contain substantial variance with an standard error of the estimate of 0.44 mL/min per gram. Myocardial flow reserve estimation was not as accurate as individual MBF estimates.
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Affiliation(s)
- Adam M Alessio
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington.,Computational Mathematics, Biomedical Engineering, and Radiology, Michigan State University (A.M.A.)
| | - Michael Bindschadler
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington
| | - Janet M Busey
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington
| | - William P Shuman
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington
| | - James H Caldwell
- Department of Radiology (A.M.A., M.B., J.M.B., W.P.S., J.H.C.), University of Washington.,Division of Cardiology, Department of Medicine (J.H.C., K.R.B.), University of Washington
| | - Kelley R Branch
- Division of Cardiology, Department of Medicine (J.H.C., K.R.B.), University of Washington
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Detecting Triple-Vessel Disease with Cadmium Zinc Telluride-Based Single-Photon Emission Computed Tomography Using the Intensity Signal-to-Noise Ratio between Rest and Stress Studies. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:4945680. [PMID: 29114176 PMCID: PMC5661073 DOI: 10.1155/2017/4945680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/10/2017] [Accepted: 08/27/2017] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to investigate if a novel parameter, the stress-to-rest ratio of the signal-to-noise ratio (RSNR) obtained with a cadmium zinc telluride (CZT) SPECT scanner, could be used to distinguish triple-vessel disease (TVD) patients. Methods. One hundred and two patients with suspected coronary artery disease were retrospectively involved. Each subject underwent a Tl-201 SPECT scan and subsequent coronary angiography. Subjects were separated into TVD (n = 41) and control (n = 61) groups based on coronary angiography results using 50% as the stenosis cutoff. The RSNR was calculated by dividing the stress signal-to-noise ratio (SNR) by the rest SNR. Summed scores were calculated using quantitative perfusion SPECT (QPS) for all subjects. Results. The RSNR in the TVD group was found to be significantly lower than that in the control group (0.83 ± 0.15 and 1.06 ± 0.17, resp.; P < 0.01). Receiver-operating characteristic (ROC) analysis showed that RSNR can detect TVD more accurately than the summed difference score with higher sensitivity (85% versus 68%), higher specificity (90% versus 72%), and higher accuracy (88% versus 71%). Conclusion. The RSNR may serve as a useful index to assist the diagnosis of TVD when a fully automatic quantification method is used in CZT-based SPECT studies.
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von Siebenthal C, Aubert JD, Mitsakis P, Yerly P, Prior JO, Nicod LP. Pulmonary Hypertension and Indicators of Right Ventricular Function. Front Med (Lausanne) 2016; 3:23. [PMID: 27376066 PMCID: PMC4891340 DOI: 10.3389/fmed.2016.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023] Open
Abstract
Pulmonary hypertension (PH) is a rare disease, whose underlying mechanisms are not fully understood. It is characterized by pulmonary arterial vasoconstriction and vessels wall thickening, mainly intimal and medial layers. Several molecular pathways have been studied, but their respective roles remain unknown. Cardiac repercussions of PH are hypertrophy, dilation, and progressive right ventricular dysfunction. Multiple echocardiographic parameters are being used, in order to assess anatomy and cardiac function, but there are no guidelines edited about their usefulness. Thus, it is now recommended to associate the best-known parameters, such as atrial and ventricular diameters or tricuspid annular plane systolic excursion. Cardiac catheterization remains necessary to establish the diagnosis of PH and to assess pulmonary hemodynamic state. Concerning energetic metabolism, free fatty acids, normally used to provide energy for myocardial contraction, are replaced by glucose uptake. These abnormalities are illustrated by increased (18)F-fluorodeoxyglucose ((18)F-FDG) uptake on positron emission tomography/computed tomography, which seems to be correlated with echocardiographic and hemodynamic parameters.
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Affiliation(s)
| | - John-David Aubert
- Pneumology, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Periklis Mitsakis
- Nuclear Medicine and Molecular Imaging, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Patrick Yerly
- Cardiology, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
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Van Tosh A, Reichek N, Palestro CJ, Nichols KJ. Effect of Outflow Tract Contributions to 82Rb-PET Global Myocardial Blood Flow Computations. J Nucl Med Technol 2016; 44:78-84. [PMID: 26966126 DOI: 10.2967/jnmt.116.173005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/08/2016] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Algorithms are able to compute myocardial blood flow (MBF) from dynamic PET data for each of the 17 left ventricular segments, with global MBF obtained by averaging segmental values. This study was undertaken to compare MBFs with and without the basal-septal segments. METHODS Data were examined retrospectively for 196 patients who underwent rest and regadenoson-stress (82)Rb PET/CT scanning for evaluation of known or suspected coronary artery disease. MBF data were acquired in gated list mode and rebinned to isolate the first-pass dynamic portion. Coronary vascular resistance (CVR) was computed as mean arterial pressure divided by MBF. MBF inhomogeneity was computed as the ratio of SD to mean MBF. Relative perfusion scores were obtained using (82)Rb-specific normal limits applied to polar maps of myocardial perfusion generated from myocardial equilibrium portions of PET data. MBF and CVRs from 17 and 14 segments were compared. RESULTS Mean MBFs were lower for 17- than 14-segment means for rest (0.78 ± 0.50 vs. 0.85 ± 0.54 mL/g/min, paired t test P < 0.0001) and stress (1.50 ± 0.88 vs. 1.67 ± 0.96 mL/g/min, P < 0.0001). Bland-Altman plots of MBF differences versus means exhibited nonzero intercept (-0.04 ± 0.01, P = 0.0004) and significant correlation (r = -0.64, P < 0.0001), with slopes significantly different from 0.0 (-7.2% ± 0.6% and -8.3% ± 0.7% for rest and stress MBF; P < 0.0001). Seventeen-segment CVRs were higher than 14-segment CVRs for rest (159 ± 86 vs. 147 ± 81 mm Hg/mL/g/min, paired t test P < 0.0001) and stress CVR (85 ± 52 vs. 76 ± 48 mm Hg/mL/g/min, P < 0.0001). MBF inhomogeneity correlated significantly (P < 0.0001) with summed perfusion scores, but values correlated significantly more strongly for 14- than 17-segment values for rest (r = 0.67 vs. r = 0.52, P = 0.02) and stress (r = 0.69 vs. r = 0.47, P = 0.001). When basal segments were included in MBF determinations, perfusion inhomogeneity was greater both for rest (39% ± 10% vs. 31% ± 10%, P < 0.0001) and for stress (42% ± 12% vs. 32% ± 11%, P < 0.0001). CONCLUSION Averaging 17 versus 14 segments leads to systematically 7%-8% lower MBF calculations, higher CVRs, and greater computed inhomogeneity. Consideration should be given to excluding basal-septal segments from standard global MBF determination.
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Affiliation(s)
- Andrew Van Tosh
- Research Department, St. Francis Hospital, Roslyn, New York; and
| | | | - Christopher J Palestro
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York
| | - Kenneth J Nichols
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York
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Juneau D, Erthal F, Ohira H, Mc Ardle B, Hessian R, deKemp RA, Beanlands RSB. Clinical PET Myocardial Perfusion Imaging and Flow Quantification. Cardiol Clin 2015; 34:69-85. [PMID: 26590781 DOI: 10.1016/j.ccl.2015.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac PET imaging is a powerful tool for the assessment of coronary artery disease. Many tracers with different advantages and disadvantages are available. It has several advantages over single photon emission computed tomography, including superior accuracy and lower radiation exposure. It provides powerful prognostic information, which can help to stratify patients and guide clinicians. The addition of flow quantification enables better detection of multivessel disease while providing incremental prognostic information. Flow quantification provides important physiologic information, which may be useful to individualize patient therapy. This approach is being applied in some centers, but requires standardization before it is more widely applied.
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Affiliation(s)
- Daniel Juneau
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Fernanda Erthal
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Hiroshi Ohira
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; First Department of Medicine, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Brian Mc Ardle
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Renée Hessian
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
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Abstract
Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review.
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Affiliation(s)
- Ran Heo
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | | | - Dan Kalra
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021.
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Hsu B, Chen FC, Wu TC, Huang WS, Hou PN, Chen CC, Hung GU. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease. Eur J Nucl Med Mol Imaging 2014; 41:2294-306. [PMID: 25143072 DOI: 10.1007/s00259-014-2881-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/28/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE Conventional dual-head single photon emission computed tomography (SPECT)/CT systems capable of fast dynamic SPECT (DySPECT) imaging have a potential for flow quantitation. This study introduced a new method to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) with DySPECT scan and evaluated the diagnostic performance of detecting coronary artery disease (CAD) compared with perfusion using invasive coronary angiography (CAG) as the reference standard. METHODS This study included 21 patients with suspected or known CAD who had received DySPECT, ECG-gated SPECT (GSPECT), and CAG (13 with ≥ 50% stenosis in any vessel; non-CAD group: 8 with patent arteries or < 50% stenosis). DySPECT and GSPECT scans were performed on a widely used dual-head SPECT/CT scanner. The DySPECT imaging protocol utilized 12-min multiple back-and-forth gantry rotations during injections of (99m)Tc-sestamibi (MIBI) tracer at rest or dipyridamole-stress stages. DySPECT images were reconstructed with full physical corrections and converted to the physical unit of becquerels per milliliter. Stress MBF (SMBF), rest MBF (RMBF), and MFR were quantified by a one-tissue compartment flow model using time-activity curves derived from DySPECT images. Perfusion images were processed for GSPECT scan and interpreted to obtain summed stress score (SSS) and summed difference score (SDS). Receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of flow and perfusion. RESULTS Using the criteria of ≥ 50% stenosis as positive CAD, areas under the ROC curve (AUCs) of flow assessment were overall significantly greater than those of perfusion. For patient-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.91 ± 0.07, 0.86 ± 0.09, 0.64 ± 0.12, and 0.59 ± 0.13. For vessel-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.81 ± 0.05, 0.76 ± 0.06, 0.62 ± 0.07, and 0.56 ± 0.08, respectively. CONCLUSION The preliminary data suggest that MBF quantitation with a conventional SPECT/CT system and the flow quantitation method is a clinically effective approach to enhance CAD detection.
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Affiliation(s)
- Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA
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12
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Abstract
Cardiac multimodality (hybrid) imaging can be obtained from a variety of techniques, such as nuclear medicine with single photon emission computed tomography (SPECT) and positron emission tomography (PET), or radiology with multislice computed tomography (CT), magnetic resonance (MR) and echography. They are typically combined in a side-by-side or fusion mode in order to provide functional and morphological data to better characterise coronary artery disease, with more proven efficacy than when used separately. The gained information is then used to guide revascularisation procedures. We present an up-to-date comprehensive overview of multimodality imaging already in clinical use, as well as a combination of techniques with promising or developing applications.
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Hsu B. PET tracers and techniques for measuring myocardial blood flow in patients with coronary artery disease. J Biomed Res 2013; 27:452-9. [PMID: 24285943 PMCID: PMC3841470 DOI: 10.7555/jbr.27.20130136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/18/2013] [Indexed: 01/05/2023] Open
Abstract
Assessment of the relative distribution of myocardial flow with myocardial perfusion imaging (MPI) is methodologically limited to predict the presence or absence of flow-limited coronary artery disease (CAD). This limitation may often occur, when obstructive lesions involve multiple epicardial coronary arteries or disease-related disturbances of the coronary circulation coexist at the microvascular level. Non-invasive assessment of myocardial blood flow in absolute units with position emission tomography (PET) has been positioned as the solution to improve CAD diagnosis and prediction of patient outcomes associated with risks for cardiac events. This article reviews technical and clinical aspects of myocardial blood flow quantitation with PET and discusses the practical consideration of this approach toward worldwide clinical utilization.
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Affiliation(s)
- Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MS 65211, USA
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Farhad H, Dunet V, Bachelard K, Allenbach G, Kaufmann PA, Prior JO. Added prognostic value of myocardial blood flow quantitation in rubidium-82 positron emission tomography imaging. Eur Heart J Cardiovasc Imaging 2013; 14:1203-10. [PMID: 23660750 DOI: 10.1093/ehjci/jet068] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We studied the respective added value of the quantitative myocardial blood flow (MBF) and the myocardial flow reserve (MFR) as assessed with (82)Rb positron emission tomography (PET)/CT in predicting major adverse cardiovascular events (MACEs) in patients with suspected myocardial ischaemia. METHODS AND RESULTS Myocardial perfusion images were analysed semi-quantitatively (SDS, summed difference score) and quantitatively (MBF, MFR) in 351 patients. Follow-up was completed in 335 patients and annualized MACE (cardiac death, myocardial infarction, revascularization, or hospitalization for congestive heart failure or de novo stable angor) rates were analysed with the Kaplan-Meier method in 318 patients after excluding 17 patients with early revascularizations (<60 days). Independent predictors of MACEs were identified by multivariate analysis. During a median follow-up of 624 days (inter-quartile range 540-697), 35 MACEs occurred. An annualized MACE rate was higher in patients with ischaemia (SDS >2) (n = 105) than those without [14% (95% CI = 9.1-22%) vs. 4.5% (2.7-7.4%), P < 0.0001]. The lowest MFR tertile group (MFR <1.8) had the highest MACE rate [16% (11-25%) vs. 2.9% (1.2-7.0%) and 4.3% (2.1-9.0%), P < 0.0001]. Similarly, the lowest stress MBF tertile group (MBF <1.8 mL/min/g) had the highest MACE rate [14% (9.2-22%) vs. 7.3% (4.2-13%) and 1.8% (0.6-5.5%), P = 0.0005]. Quantitation with stress MBF or MFR had a significant independent prognostic power in addition to semi-quantitative findings. The largest added value was conferred by combining stress MBF to SDS. This holds true even for patients without ischaemia. CONCLUSION Perfusion findings in (82)Rb PET/CT are strong MACE outcome predictors. MBF quantification has an added value allowing further risk stratification in patients with normal and abnormal perfusion images.
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Affiliation(s)
- Hoshang Farhad
- Nuclear Medicine Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland
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Alexánderson E, Jácome R, Jiménez-Santos M, Ochoa JM, Romero E, Cabral MAP, Ricalde A, Iñarra F, Meave A, Alexánderson G. Evaluation of the endothelial function in hypertensive patients with 13N-ammonia PET. J Nucl Cardiol 2012; 19:979-86. [PMID: 22689073 DOI: 10.1007/s12350-012-9584-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/15/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Essential hypertension is one of the main risk factors for the development of coronary artery disease (CAD). Hypertension causes endothelial dysfunction which is considered an early sign for the development of CAD. Positron emission tomography is a non-invasive imaging technique that measures myocardial blood flow (MBF), allowing us to identify patients with endothelial dysfunction. METHODS AND RESULTS 19 patients without comorbidities recently diagnosed hypertensive, as well as 21 healthy volunteers were studied. A three-phase (rest, cold pressor test, and adenosine-induced hyperemia) (13)N-ammonia PET was performed, and MBF was measured. Endothelial-Dependent Vasodilation Index, ΔMBF, and coronary flow reserve (CFR) were calculated for each patient. Hypertensive patients had a significantly higher systolic and diastolic blood pressures compared with the control group (134.6 ± 11.7/86.4 ± 10.6 mm Hg and 106.0 ± 11.8/71.4 ± 6.6 mm Hg, respectively, P < .001). The ENDEVI (1.28 ± 0.26 vs 1.79 ± 0.30, P < .001), the ΔMBF (0.81 ± 0.50 vs 0.25 ± 0.21, P < .001) and the CFR (2.18 ± 0.88 vs 3.17 ± 0.68, P = .001) were significantly lower in the hypertensive patients compared to the control group, 84% of the former group had endothelial dysfunction i.e., ENDEVI < 1.5 and 58% had vasomotor abnormalities, i.e., CFR < 2.5. CONCLUSIONS In this study, we showed that recently diagnosed hypertensive patients have coronary endothelial dysfunction and vasomotor disturbances which are early signs for the development of CAD.
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Affiliation(s)
- Erick Alexánderson
- Unidad PET/CT Ciclotrón, Facultad de Medicina, Universidad Nacional Autónoma de México, Edificio de Investigación, Planta Baja, Ciudad Universitaria, CP 04510, Mexico City, DF, Mexico.
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Quantification of myocardial blood flow with 82Rb positron emission tomography: clinical validation with 15O-water. Eur J Nucl Med Mol Imaging 2012; 39:1037-47. [PMID: 22398957 PMCID: PMC3342496 DOI: 10.1007/s00259-012-2082-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 02/01/2012] [Indexed: 12/22/2022]
Abstract
Purpose Quantification of myocardial blood flow (MBF) with generator-produced 82Rb is an attractive alternative for centres without an on-site cyclotron. Our aim was to validate 82Rb-measured MBF in relation to that measured using 15O-water, as a tracer 100% of which can be extracted from the circulation even at high flow rates, in healthy control subject and patients with mild coronary artery disease (CAD). Methods MBF was measured at rest and during adenosine-induced hyperaemia with 82Rb and 15O-water PET in 33 participants (22 control subjects, aged 30 ± 13 years; 11 CAD patients without transmural infarction, aged 60 ± 13 years). A one-tissue compartment 82Rb model with ventricular spillover correction was used. The 82Rb flow-dependent extraction rate was derived from 15O-water measurements in a subset of 11 control subjects. Myocardial flow reserve (MFR) was defined as the hyperaemic/rest MBF. Pearson’s correlation r, Bland-Altman 95% limits of agreement (LoA), and Lin’s concordance correlation ρc (measuring both precision and accuracy) were used. Results Over the entire MBF range (0.66–4.7 ml/min/g), concordance was excellent for MBF (r = 0.90, [82Rb–15O-water] mean difference ± SD = 0.04 ± 0.66 ml/min/g, LoA = −1.26 to 1.33 ml/min/g, ρc = 0.88) and MFR (range 1.79–5.81, r = 0.83, mean difference = 0.14 ± 0.58, LoA = −0.99 to 1.28, ρc = 0.82). Hyperaemic MBF was reduced in CAD patients compared with the subset of 11 control subjects (2.53 ± 0.74 vs. 3.62 ± 0.68 ml/min/g, p = 0.002, for 15O-water; 2.53 ± 1.01 vs. 3.82 ± 1.21 ml/min/g, p = 0.013, for 82Rb) and this was paralleled by a lower MFR (2.65 ± 0.62 vs. 3.79 ± 0.98, p = 0.004, for 15O-water; 2.85 ± 0.91 vs. 3.88 ± 0.91, p = 0.012, for 82Rb). Myocardial perfusion was homogeneous in 1,114 of 1,122 segments (99.3%) and there were no differences in MBF among the coronary artery territories (p > 0.31). Conclusion Quantification of MBF with 82Rb with a newly derived correction for the nonlinear extraction function was validated against MBF measured using 15O-water in control subjects and patients with mild CAD, where it was found to be accurate at high flow rates. 82Rb-derived MBF estimates seem robust for clinical research, advancing a step further towards its implementation in clinical routine.
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Heller GV. Practical issues regarding the incorporation of PET into a busy SPECT practice. J Nucl Cardiol 2012; 19 Suppl 1:S12-8. [PMID: 22160728 DOI: 10.1007/s12350-011-9493-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Incorporating positron emission tomography (PET) imaging or PET/computed tomographic (PET/CT) imaging into a clinical cardiology practice provides opportunities to better assess patients as well as to expand the services offered by the practice. Clinical evidence continues to accrue, demonstrating the superior quality, the breadth of assessments possible, the diagnostic certainty and accuracy, and the lower patient radiation exposure of PET versus single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI). PET imaging is more accessible to non-hospital imaging centers than ever before because of the availability of radiopharmaceuticals that can be generated on-site or delivered in unit doses from regional cyclotrons, and camera systems of lower cost than previously available. In this manuscript, we offer guidance on the many factors a practice must address before replacing an aging SPECT camera or adding new PET or PET/CT imaging capabilities. Key among these are defining the PET and CT procedures the practice members wish to perform, learning the equipment and radiotracers required to perform those procedures, determining whether their facility has sufficient physical space and shielding to accommodate the dedicated PET or PET/CT instrumentation, and addressing issues related to the practice's referral base, competition, cost-of-entry, reimbursement, and return on investment.
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Affiliation(s)
- Gary V Heller
- Division of Cardiology, Hartford Hospital, Hartford, CT 06102, USA.
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Abstract
An ideal positron emission tomography (PET) tracer should be highly extractable by the myocardium and able to provide high-resolution images, should enable quantification of absolute myocardial blood flow (MBF), should be compatible with both pharmacologically induced and exercise-induced stress imaging, and should not require an on-site cyclotron. The PET radionuclides nitrogen-13 ammonia and oxygen-15 water require an on-site cyclotron. Rubidium-82 may be available locally due to the generator source, but greater utilization is limited because of its relatively low myocardial extraction fraction, long positron range, and generator cost. Flurpiridaz F 18, a novel PET tracer in development, has a high-extraction fraction, short positron range, and relatively long half-life (as compared to currently available tracers), and may be produced at regional cyclotrons. Results of early clinical trials suggest that both pharmacologically and exercise-induced stress PET imaging protocols can be completed more rapidly and with lower patient radiation exposure than with single-photon emission computerized tomography (SPECT) tracers. As compared to SPECT images in the same patients, flurpiridaz F 18 PET images showed better defect contrast. Flurpiridaz F 18 is a potentially promising tracer for assessment of myocardial perfusion, measurement of absolute MBF, calculation of coronary flow reserves, and assessment of cardiac function at the peak of the stress response.
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Affiliation(s)
- Jamshid Maddahi
- Department of Molecular and Medical Pharmacology (Nuclear Medicine), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095-7064, USA.
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Abstract
Microvascular angina (MVA) is an often overlooked cause of significant chest pain. Decreased myocardial perfusion secondary to dysregulated blood flow in the microvasculature can occur in the presence or absence of obstructive epicardial coronary artery disease. The corresponding myocardial ischemia and angina is now a well-established diagnosis, made by detection of decreased coronary flow reserve (CFR). Although low CFR and MVA are associated with poor prognosis, there is initial evidence for reversibility of this abnormal vascular regulation with aggressive medical therapy and control of associated risk factors. Current assessment of MVA is carried out predominantly during cardiac catheterization; however, noninvasive techniques to assess CFR are being developed, including PET, MRI, and CT modalities. Quantitative tracer techniques or imaging of metabolic disturbances reflecting ischemia will likely enhance diagnostic approaches for such patients as well as allow more frequent monitoring of response to therapy.
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Fukushima K, Javadi MS, Higuchi T, Lautamäki R, Merrill J, Nekolla SG, Bengel FM. Prediction of Short-Term Cardiovascular Events Using Quantification of Global Myocardial Flow Reserve in Patients Referred for Clinical 82Rb PET Perfusion Imaging. J Nucl Med 2011; 52:726-32. [DOI: 10.2967/jnumed.110.081828] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Alexánderson E, Ochoa JM, Calleja R, Juárez-Rojas JG, Prior JO, Jácome R, Romero E, Meave A, Posadas-Romero C. Endothelial Dysfunction in Systemic Lupus Erythematosus: Evaluation with 13N-Ammonia PET. J Nucl Med 2010; 51:1927-31. [DOI: 10.2967/jnumed.110.078212] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Shikata F, Imagawa H, Kawachi K, Kido T, Kurata A, Inoue Y, Hosokawa K, Nagao M, Higashino H, Mochizuki T, Ryugo M, Nagashima M. Regional myocardial blood flow measured by stress multidetector computed tomography as a predictor of recovery of left ventricular function after coronary artery bypass grafting. Am Heart J 2010; 160:528-34. [PMID: 20826263 DOI: 10.1016/j.ahj.2010.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/16/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multidetector-row computed tomography (MDCT) applications have expanded to evaluation of myocardial blood flow (MBF) and viability. We quantified regional MBF pre- and post-coronary artery bypass grafting (CABG) using adenosine stress and cardiac 64-MDCT, and investigated whether the results predict MBF and left ventricular (LV) function recovery after CABG. METHODS We studied 321 regions in 19 CABG patients who underwent adenosine stress 64-row MDCT perfusion imaging and cine magnetic resonance imaging pre- and post-CABG. Myocardial blood flow was estimated from linear regression equation slopes using Patlak plot analyses and compared with LV function by measuring wall thickening (%WT) using cine magnetic resonance imaging. RESULTS Overall mean MBFs were 1.39 +/- 0.49 and 1.95 +/- 0.49 mL/(g min) pre- and post-CABG (P < .0001). Myocardial blood flow in revascularized areas increased significantly (pre-CABG 1.18 +/- 0.45, post-CABG 1.99 +/- 0.66 mL/[g min], P < .001), whereas nonischemic areas showed no difference (1.79 +/- 0.70 and 1.97 +/- 0.46 mL/[g min], P = .14). Revascularized areas with preoperative MBF > or = 0.9 mL/(g min) showed significantly greater MBF improvement than those with preoperative MBF <0.9 mL/(g min) (P = .04). In patients with preoperative LV dysfunction (ejection fraction <40%), %WT in revascularized areas with pre-CABG MBF > or = 0.9 mL/(g min) improved significantly after CABG (pre-%WT 40.9 +/- 22.9, post-%WT 52.8 +/- 20.6, P = .03) versus those with pre-CABG MBF <0.9 mL/(g min) (pre-%WT 53.2 +/- 35.5, post-%WT 42.5 +/- 17.0, P = .40). CONCLUSIONS Our results demonstrated more significantly increased MBF post-CABG than pre-CABG, particularly in revascularized areas. Regional MBF before CABG may predict MBF and LV function recovery, in the short term, after CABG.
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Ziadi MC, Beanlands RSB. The clinical utility of assessing myocardial blood flow using positron emission tomography. J Nucl Cardiol 2010; 17:571-81. [PMID: 20552310 DOI: 10.1007/s12350-010-9258-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Maria Cecilia Ziadi
- Molecular Function and Imaging Program, The National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Quantification of regional myocardial blood flow in a canine model of stunned and infarcted myocardium: comparison of rubidium-82 positron emission tomography with microspheres. Nucl Med Commun 2010; 31:67-74. [PMID: 19823095 DOI: 10.1097/mnm.0b013e328332b32a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial viability and quantification of regional myocardial blood flow (MBF) are important for the diagnosis of heart disease. Positron emission tomography is the current gold standard for determining myocardial viability, but most positron-emitting perfusion tracers require an on-site cyclotron. Rubidium-82 ((82)Rb) is a myocardial perfusion tracer that is produced using an on-site generator. This study investigates (82)Rb-measured MBF in canine models of stunned and infarcted myocardium compared with selected measurements obtained concurrently using microspheres. METHODS Myocardial stunning and infarction were created in canines by occluding the left anterior descending for 15 min and 2 h, respectively. Stunning was produced in all animals; six animals were reperfused after the 2 h occlusion, whereas the other six animals remained occluded permanently. Regional MBF was measured in each group during rest and dobutamine stress at acute and chronic (8 weeks postinsult) time points using dynamic (82)Rb perfusion imaging and radioactively labeled microspheres. RESULTS Average resting MBF with microspheres and Rb was 0.68+/-0.02 versus 0.73+/-0.01 (P<0.001) in nonischemic tissue, and 0.53+/-0.03 versus 0.42+/-0.02 (P<0.001) in the region-at-risk tissue, respectively. Average MBF during stress with microspheres and Rb was 2.78+/-0.15 versus 3.53+/-0.16 (P<0.05) in the nonischemic tissue, and 1.90+/-0.20 versus 2.31+/-0.26 (P = NS) in the region-at-risk tissue, respectively. CONCLUSION Despite the small significant differences, the dynamic (82)Rb measurements provide estimates of MBF in stunned and acutely and chronically infarcted tissue at rest and during hyperemia that correspond with clinical interpretation.
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Galiuto L, Natale L, Leccisotti L, Locorotondo G, Giordano A, Bonomo L, Crea F. Non-invasive imaging of microvascular damage. J Nucl Cardiol 2009; 16:811-31. [PMID: 19705211 DOI: 10.1007/s12350-009-9134-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/06/2009] [Indexed: 01/29/2023]
Affiliation(s)
- L Galiuto
- Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Largo A. Gemelli, 8, 00168, Rome, Italy.
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