Simultaneous 18F-labeled AlF-FAPI PET/MR images targeting the myocardial fibrosis in coronary artery disease and degenerative mitral valve regurgitant participants with left ventricular mechanical dyssynchrony

Figures

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  Fig. 1. Participants selection flowchart. CAD, Coronary Artery Disease; CAG, Coronary Arteriography; CTCA, Computed Tomography Coronary Angiography; MVR, Mitral Valve Regurgitation; PET/MR, Positron Emission Tomography/Magnetic Resonance.

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  Fig. 2. Images in a 64-year-old woman with multiple coronary stenosis (A‒H). 18F-AlF-FAPI PET images, MR images, and PET/MR fusion images in short-axis, vertical long-axis, and horizontal long-axis cine (A). The distribution of FAPI uptake in the polar map of PET images (B). There were higher FAPI uptake in the septum and inferior myocardium. The polar map of the percentages of systolic LV wall thickening per myocardial segment in MR images (C). The polar map of the percentage ranges of systolic LV wall thickening in PET images (D). Both C and D showed that the wall thickening decreased in the septum and inferior myocardium. The polar maps of the peak circumferential, longitudinal, long-axis radial and short-axis radial strains per myocardial segment in MR images (E‒H). The correlation analysis between the percentages and scores of systolic LV wall thickening, the peak circumferential, longitudinal, long-axis radial and short-axis radial strains and SUVmean in 16 myocardial segments from all participants (I‒N). There were significant negative correlation between SUVmean and the percentages (I) and scores (J) of systolic LV wall thickening, the peak circumferential (K) and short-axial…

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  Fig. 3. Representative images in participants with coronary stenosis. Curved reconstruction map (A, C, E) and probe map (B, D, F) obtained from Computed Tomography Angiography (CTA) showed the vascular stenosis (indicated by red arrow). 18F-FAPI PET images (G, H, I), MRI images (J, K, L), and PET/MR fusion image (M, N, O) in short-axis cine showed that FAPI was up-taken in a certain slicer. The distribution of FAPI-uptake in the left ventricle was presented with a polar map (P, Q, R). The first column showed images in a 42-year-old man with 50% stenosis in Left Anterior Descending coronary artery (LAD) and 30% stenosis in Right Coronary Artery (RCA). In the short-axis cardiac PET/MR fusion images, the uptake of FAPI in the septum was higher (M), and in the polar map of PET images, the anterior and septal wall had higher uptake (P). The second column showed images in a 61-year-old woman with 40% stenosis in RCA. FAPI-uptake increased in the inferoseptal and inferior wall in the short-axis cardiac PET/MR fusion images and the polar map of PET images (N and Q). The third column showed images in a 67-year-old man with 50% stenosis in Left Circumflex Artery (LCX), 30% stenosis in LAD and 30%…

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  Fig. 4. The comparison of SUVmean in the myocardium fed by every coronary artery in each participant with Coronary Artery Disease (CAD) (A) For each participant, FAPI uptake was significantly higher in the myocardium fed by the narrow coronary artery than that fed by normal coronary artery. The comparison of SUVmean between in the myocardium fed by the coronary artery with stenosis in CAD participants and in those fed by the corresponding normal coronary artery in normal ones (B). It showed that uptake of FAPI in the myocardium fed by every coronary artery with stenosis was significantly higher than that in the same myocardium fed by non-occluded coronary artery. The correlation analysis between percentage of wall thickening and SUVmean in the myocardium fed by anterior descending coronary artery (LAD), Right Coronary Artery (RCA) and Left Circumflex Artery (LCX), respectively (C‒E). The correlation analysis between the peak circumferential and short-axis radial strains and displacements and SUVmean in LAD and RCA, respectively (F‒M). The correlation analysis between the long-axis radial strains and displacements and SUVmean in LCX (N‒O). Each column represents mean ± SD. Asterisks…

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  Fig. 5. Images in a 63-year-old man with Mitral Valve Regurgitation (MVR) (A and B). 18F-AlF-FAPI PET images, MR images, and PET/MR fusion images in short-axis, vertical long-axis, and horizontal long-axis cine (A). The distribution of FAPI uptake in the polar map of PET images (B). There were higher FAPI uptakes in the middle myocardium, especially in the mid anterior, mid inferior and mid anterolateral wall. The uptakes of FAPI in each myocardial segment in the polar map of PET images from all participants with MVR (C). The value of SUVmean of FAPI-uptakes in each segment was represented by the width of each color bar. It showed that for each participant with MVR, there were no significant differences in FAPI-uptakes between each myocardial segment. The comparison of SUVmean between two parts of all myocardial segments in each participant with MVR (D). In each participant, SUVmean of FAPI uptakes in the part of myocardial segments, including basal inferoseptal, basal inferior, mid inferior and mid anterolateral wall, was higher than that in the other part including the remaining myocardial segments. The comparison of SUVmean in the basal inferoseptal, basal inferior, mid inferior and…

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  Fig. 6. The correlation analysis between regurgitant volume, regurgitant fraction, regurgitant orifice area, ejection fraction and SUVmean in the basal inferoseptal (A‒D), basal inferior (E‒H), mid inferior (I‒L) and mid anterolateral segments (M‒P) from MVR participants.