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Review
. 2020 Sep 1;93(1113):20190836.
doi: 10.1259/bjr.20190836. Epub 2020 Feb 14.

Positron emission tomography/MRI for cardiac diseases assessment

Osamu Manabe  1 , Noriko Oyama-Manabe  1 , Nagara Tamaki  2
Affiliations
Review

Positron emission tomography/MRI for cardiac diseases assessment

Osamu Manabe et al. Br J Radiol. .

Abstract

Functional imaging tools have emerged in the last few decades and are increasingly used to assess the function of the human heart in vivo. Positron emission tomography (PET) is used to evaluate myocardial metabolism and blood flow. Magnetic resonance imaging (MRI) is an essential tool for morphological and functional evaluation of the heart. In cardiology, PET is successfully combined with CT for hybrid cardiac imaging. The effective integration of two imaging modalities allows simultaneous data acquisition combining functional, structural and molecular imaging. After PET/CT has been successfully accepted for clinical practices, hybrid PET/MRI is launched. This review elaborates the current evidence of PET/MRI in cardiovascular imaging and its expected clinical applications for a comprehensive assessment of cardiovascular diseases while highlighting the advantages and limitations of this hybrid imaging approach.

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Figures

Figure 1.
Figure 1.
PET/MRI systems can be the separated PET and MR system (a) or the integrated PET/MRI (b). The latter is classified into two different types, where the PET gantry is inserted in the bore of a standard MRI scanner (c) or the PET and MRI are fully integrated into a single gantry (d). PET, positron emission tomography; MRI, magnetic resonance imaging; RF, radiofrequency
Figure 2.
Figure 2.
Sample imaging protocols for cardiac PET/MRI SPAIR, spectral attenuated with inversion recovery; LGE, late gadolinium enhancement; FDG, 18F-fluorodeoxyglucose; PET, positron emission tomography
Figure 3.
Figure 3.
Viability assessment A patient with stenosis of the left anterior descending and the right coronary arteries was assessed for myocardial viability. Left ventricular short-axis images of MRI LGE (a), fused image of LGE and PET (b), and FDG PET with insulin-clamp method (c) are displayed. Different patterns can be observed as; normal physiological 18F-FDG uptake and no LGE (red arrow), reduced or absent FDG uptake and transmural LGE (white arrows), and subendocardial LGE but preserved FDG uptake lesions (yellow arrow). FDG, 18F-fluorodeoxyglucose; PET, positron emission tomography; MRI, magnetic resonance imaging; LGE, late gadolinium enhancement
Figure 4.
Figure 4.
Cardiac sarcoidosis A patient in her 70s with systemic sarcoidosis was assessed for a cardiac lesion. Left ventricular short-axis images of MRI LGE (a), fused image of LGE and PET (b), and FDG PET with long-fasting and low-carbohydrate food preparations (c) is displayed. LGEs in the septum (red arrow) and papillary muscle (white arrow) are detected. Physiological myocardial FDG uptake was well suppressed. Focal FDG uptakes were detected in the areas with MRI LGE, which indicate active inflammation. FDG, 18F-fluorodeoxyglucose; PET, positron emission tomography; MRI, magnetic resonance imaging; LGE, late gadolinium enhancement
Figure 5.
Figure 5.
Hypertrophic cardiomyopathy eft ventricular short-axis images of MRI LGE (a), fused image of LGE and PET (b), and FDG PET with long-fasting and unfractionated heparin injection (c) is displayed. Septal hypertrophy with patchy LGE and slight FDG uptakes (red arrow) are detected, which may be due to the metabolic energy shift or inflammatory response. FDG, 18F-fluorodeoxyglucose; PET, positron emission tomography; MRI, magnetic resonance imaging; LGE, late gadolinium enhancement
See this image and copyright information in PMC

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