PET:n uusimmat diagnostiset mahdollisuudet sydänpotilailla

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1 :n uusimmat diagnostiset Kotka 1 Juhani Knuuti Nuclear perfusion imaging Diagnosis and prognosis of CAD Annual cardiac event rate % normal P <.1,6 1 % 8 % 6 % % % % n = 1 pts Metanalysis, 896 pax ROBUST, 65 pax 91 % 86 % 87 % 7 % 89 % Sensitivity Specificity Normalcy 7, abnormal Severity of CAD in nuclear imaging Challenge Balanced 3 vessel disease Multivessel disease Non-ischemic CAD Microvascular disease Solution 1

2 Severity of CAD in nuclear imaging Quantification of myocardial blood flow: Different kinetics in different tracers 6 Challenge Balanced 3 vessel disease Multivessel disease Non-ischemic CAD Microvascular disease Solution Hybrid imaging Measured/modelled flow O-water 13 N-ammonia 8 Rb 1 Tl 1 99m Tc-MIBI Absolute flow (ml/g/min) 1 unselected examples of relative vs quantitative analysis Relative Absolute Relative Absolute Relative Absolute perfusion imaging during stress Displayed as fused volume rendered images scaled to absolute scale -3.5 ml/g/min Normal perfusion: above.5 ml/g/min: yellow or red 3.5 ml/g/min. ml/g/min Acquisition: Injected Dose: 11 MBq O-15-water Stress: Adenosine 1 µg/min/kg for 6.5 min Acquisition time: dynamic.5 min Radiation dose.9 msv CT angiography Case LP Invasive angiography + FFR Case LP Curved MPR reconstructions of the major coronary vessels LCX >5% 3-% RCA >5% Right 8% FFR:.86 (normal) Left 6% FFR:? 6% FFR:.9 (normal) CT Acquisition: Premedication: Metoprolol 1 mg i.v. HR 6/min Acquisition: Prospective step-and-shoot protocol, ma65, 1 kv Contrast: Iomeron mg/ml 68 ml Radiation dose 7. msv FFR = Fractional flow reserve invasive measurement of the stenosis functional gradient during adenosine infusion

3 /CT against ICA+FFR for CAD Figure b: Vessel Analysis against ICA+FFR Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%) MDCT MDCT- hybrid Cardiac CTA + perfusion protocol Scouts Calcium score CTA CTAC Stress perfusion WA Adenosine CT scan scan Tracer injection Contrast injection Radiation dose CTA: 3-7 msv : 1 msv Total dose <1 msv MDCT MDCT- hybrid Kajander at al submitted Time (min) F-BMS perfusion images in rat AMI New perfusion tracers Permanent ligation min ligation Transverse Coronal Sagittal Ga-68 tracers Cheap rator based Control 68-Ga-Bis(3-MeO-sal)MeBAPEN Sherif, Saraste Circ Cardiovasc Imaging MI patients per study Stenosis as a predictor of MI Stenosis prior to MI Ambrose >7% 5 7% <5% Little Nobuyoshi Giroud 1% % 68% All MI patients total Falk

4 In vivo assessment of coronary atherosclerotic plaque using MSCT Imaging of Unstable Atherosclerotic Carotid-Artery and Aortic Lesions Characteristics of high risk lesion - Large volume (- Lesion density) - Mixed composition - Positive remodelling MRI- (F-FDG) Hoppela et al (unpublished) LCX Reproducibility: Intraclass correlation coefficient >.9 Left main Turku Centre Rudd et al J Am Coll Cardiol 7;5:89 6) F-FDG /CT of the culprit artery in a patient with acute myocardial infarction Dual gated F-FDG /CT of the culprit artery in acute NSTEMI Acute RCA occlusion, previous stenting CTA CTA- Fusion Acute plaque rupture Myocardial FDG uptake supressed by low carbohydrate, high fat diet Myocardial FDG uptake supressed by low carbohydrate, high fat diet Turku Centre, Finland F-Galacto-RGD uptake in mouse atherosclerotic plaques F-galacto-RGD Fusion CT angiography In vivo Autoradiography F-galacto-RGD Autoradiography A B HE staining LDLR/ApoB8 double knockout mice Laitinen and Saraste Circ Cardiovasc Imaging 9

5 Sydänlihaksen elkinkylyisyys FDG /CT Sarkoidoosi FDG + perfuusio Turku Centre, Finland Presynaptic Sympathetic Innervation Stem Cell Nerve Terminal Adrenocept or Stem Cell Engraftment Catecholamin e Analogue Glucose Postsynaptic Adrenergic Receptors ATR Mitochondrium ACE Inhibitor ACE Cardiac Molecular Imaging Targets ATR Renin- Angiotensin System (RAS) Matrix- Metalloproteina se MMP Nucleus Product MMP αvβ3 Integrin α v β 3 Integrin Expression Vector Integrin Expression / Imaging FFA TCA Flux Probe Glucose Bengel, F. Analogue In: Braunwald s Heart Disease, 8th Ed. Fatty Acid Analogue Metabolism Acetate Membrane Integrity / Annexin Antimyosin Apoptosis / Cell Death 5