Meave-González A, Maury-Ordaz S, Magaña-Bailón E, Barrero-Mier AF, Jordán-Ríos A, Martínez-Aguilar MM, Alexanderson-Rosas E

Language: Spanish
References: 16
Page: 110-116
PDF size: 402.95 Kb.

ABSTRACT

Objective: determine the diagnostic value of myocardial perfusion studies with 13N-ammonia PET.
Methodology: this study retrospectively reviewed all files from cases evaluated in the Cardiovascular area of the UNAM Medical School PET/ CT Cyclotron Unit from the year 2003 through the year 2013 (1004 cases in all). We identified demographic data, prevalence of risk factors and prior infarction, as well as the results of the studies performed. Of results of perfusion by PET and coronary anatomy by CT, we studied 348 patients and analyzed sensitivity, specificity, positive predictive value, and negative predictive value.
Results: of the 1004 patients evaluated, 64% were males (average age 60.2 ± 3.7). The principal cardiovascular risk factors present were: smoking (35.5%), systemic arterial hypertension (34%), dyslipidemia (33.7%), and type 2 diabetes mellitus (19.5%), with 16% of patients with history of myocardial infarction. Symptoms included typical angina 25%, atypical angina 15%, dyspnea 10%, syncope 6%, tachycardia 4%, and non-specific symptoms 5%. Of the hybrid studies performed, 73% showed ischemia and/or necrosis by PET and 55.2% showed coronary stenosis by CT. The relationship between the degree of stenosis by CT and ischemia by PET was statistically significant (p = 0.001) and the relationship between the degree of ischemia (moderate or severe) and the presence of significant stenosis was p = 0.001. The sensitivity of PET in detecting significant lesions was 92%, specificity 35%, positive predictive value (PPV) 37% and negative predictive value (NPV) 91%.
Conclusion: 13N-ammonia PET has high diagnostic sensitivity for detection of myocardial ischemia correlated with findings of coronary angiotomography. This would be the largest series of studies of myocardial perfusion with PET and angiotomography in Latin America.

REFERENCES

1. Knaapen P, de Haan S, Hoekstra OS, Halbmeijer R, et al. Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease. NethHeart J 2010;18(2):90-8.

2. Wu JC, Chen IY, Wang Y, et al. Molecular imaging of the kinetics of vascular endothelial growth factor gene expression in ischemic myocardium. Circulation 2004;110(6):685-91.

3. Seibert JA. X-ray imaging physics for nuclear medicine technologists. Part 1: Basic principles of x-ray production. J Nucl Med Technol 2004;32(3):139-47.

4. Seibert JA, Boone JM. X-ray imaging physics for nuclear medicine technologists. Part 2: X-ray interactions and image formation. J Nucl Med Technol 2005;33(1):3-18.

5. Votaw JR. The AAPM/RSNA physics tutorial for residents. Physics of PET. Radiographics 1995;15(5):1179-90.

6. Turkington TG. Introduction to PET instrumentation. J Nucl Med Technol 2001;29(1):4-11.

7. Kapoor V, McCook BM, Torok FS. An introduction to PET-CT imaging. Radiographics 2004;24(2):523-43.

8. Pannu HK, Flohr TG, Corl FM, Fishman EK. Current concepts in multi-detector row CT evaluation of the coronary arteries: principles, techniques, and anatomy. Radiographics 2003;23:S111-25.

9. Schoenhagen P, Stillman AE, Halliburton SS, White RD. CT of the heart: principles, advances, clinical uses. CleveClin J Med 2005;72(2):127-38.

10. Schindler et al. Emerging Role of PET Imaging. Cardiovascular Imaging JACC 2010;3(6):623– 40.

11. Bamonde-Tejeda Jorge. Adaptación miocárdica a la isquemia o infarto. RPSMI 2002;15(4):12-5.

12. Erick Alexánderson, Patricio Cruz, Carlos Sierra, José Antonio Talayero, Aloha Meave. Cardiopatía isquémica: evaluación anatomofuncional en una sola exploración con PET-CT multicorte. Arch Cardiol Mex 2006;76:111-20.

13. Alexánderson E, ricalde A, Zerón J, Talaye roja, Cruz P, Adame G, Mendoza G, Meave A. El patrón discordante, representación visual de viabilidad miocárdica con PET. Arch Cardiol Mex 2006;76:347-54.

14. Rodríguez Garrido M, Asensio del Barrio C. Agencia de Evaluación de Tecnologías Sanitarias (AETS) Instituto de Salud Carlos III - Ministerio de Sanidad y Consumo «PETTAC: Indicaciones, revisión sistemática y meta-análisis» Madrid: AETS - Instituto de Salud Carlos III, Junio de 2004.

15. Adil Bashir, Robert J. Gropler. Translation of Myocardial Metabolic Imaging Concepts into the Clinics. Cardiol Clin 2009;27:291–310.

16. Erick Alexanderson Rosas, Nora E Kerik, Samuel Unzek Freiman, Salomón Fermon Schwaycer. Principios y aplicaciones de la tomografía por emisión de positrones (PET) en la cardiología. PET en México: Arch Cardiol Mex 2002;72:157-164.