Coronary artery disease imaging with total-body PET.

Figures

• 

  Figure 1. Limitations of coronary PET. (A and B) Partial volume effect. A discrete lesion partially occupies several voxels at its periphery (A), as a result the values of intensity of the lesion within these voxels are averaged with the background creating blurring of the image (B). (C and D) Motion artifact leading to distortion and apparent duplication of the right coronary artery on attenuation correction computed tomography (blue arrow, C). Leading to difficulty determining whether focal [68Ga]-FAPI-46 uptake originates from the right coronary artery (blue arrow, D). Motion artifact of the patient’s previous transcatheter aortic valve replacement can also be seen (green arrow, C). (E and F) Pericardial overspill into coronary arteries with a 5-mm radius volume of interest drawn around the left anterior descending artery (green lines). On axial imaging, there appears to be focal [68Ga]-FAPI-46 uptake within the left anterior descending artery (blue arrow, E). However, on the coronal slice, there is apparent [68Ga]-FAPI-46 overspill from the surrounding pericardium (blue arrow, F). Uptake of [68Ga]-FAPI-46 at the site of the recent midline sternotomy can also be seen (green arrow, E).

• 

  Figure 2. Coronary motion correction. This figure has been adapted from research that was originally published in the European Journal of Nuclear Medicine and Molecular Imaging by Kwiecinski et al.32 (A) Whole-vessel tubular and tortuous CT angiography derived volume of interest for [18F]-NaF uptake assessment in the left anterior descending artery (blue arrow). (B) Three-dimensional rendering of coronary CT angiography with superimposed tubular whole-vessel volumes of interest (light green) employed for evaluation of [18F]-sodium fluoride uptake (blue and red). Abbreviation: TBR = target-to-background ratio.

• 

  Figure 3. Comparison between [68Ga]-DOTATATE and [18F]-FDG coronary PET inflammation imaging. This figure has been adapted from research that was originally published in the Journal of the American College of Cardiology by Tarkin et al.47 Images from a 57-year-old man with acute coronary syndrome who presented with deep anterolateral T-wave inversion. (A and B) [18F]-FDG PET uptake causes myocardial spillover and completely obscures the coronary arteries. In contrast, [68Ga]-DOTATATE PET (C and D) clearly detects intense inflammation in this high-risk atherosclerotic plaque/distal portion of the stented culprit lesion (arrow and * on insert) and recently infarcted myocardium (* on panel D).

• 

  Figure 4. Patients with stable angina and [18F]-fluoride uptake. This research was originally published in the Lancet by Joshi et al (supplementary materials).14 Representative examples for [18F]-fluoride uptake in patients with stable angina. (A-D) Computed tomography coronary angiograms; (E-H) [18F]-fluoride positron emission tomograms; (I-L) fused positron emission tomograms and computed tomography coronary angiograms.

• 

  Figure 5. Exemplar cases of coronary [18F]-GP1 uptake in patients treated for ST-segment elevation myocardial infarction. This figure has been adapted from an originally published in the Journal of the American College of Cardiology Cardiovascular Imaging by Tzolos et al.74 Anterior (A), lateral (B), and inferior (C) myocardial infarction and corresponding [18F]-GP1 uptake from the corresponding culprit artery (blue arrows). Right to left: CT angiogram, and [18F]-GP1 positron emission tomographic and CT angiogram. [18F]-GP1 uptake was noted only in the infarct artery.

• 

  Figure 6. Coronary [68Ga]-FAPI-46 uptake. A patient with recent coronary artery bypass graft surgery (NCT06800430). (A and B) [68Ga]-FAPI-46 uptake visualized in the left main stem on axial imaging with apparent co-localization to hypo attenuated plaque (blue arrows). Uptake of [68Ga]-FAPI-46 at the site of the recent midline sternotomy can also be seen (green arrows). (C and D) Localization of [68Ga]-FAPI-46 uptake to the left main stem confirmed on oblique imaging (blue arrows). Pericardial and myocardial uptake of [68Ga]-FAPI-46 can be visualized, in-keeping with recent coronary artery bypass graft surgery (A and C).

• 

  Figure 7. Coronary [18F]-GP1 uptake in a patient with spontaneous coronary artery dissection. This research was originally published in the Journal of the American College of Cardiology Cardiovascular Imaging by Tzolos et al. (supplementary materials).74 Patient with anterior ST-elevation myocardial infarction. (Left) Distal left anterior descending coronary artery tapering suggestive of spontaneous coronary artery dissection (green arrow) and (Middle and Right) subsequent [18F]-GP1 PET and computed tomography angiogram with uptake in the distal left anterior descending coronary artery.