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Cardiac Positron Emission Tomography pp 51–73Cite as

Cardiac Metabolism: Positron Emission Tomography Versus Single Photon Emission Computed Tomography

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Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 166))

Abstract

Many noninvasive methods for imaging cardiac metabolism have been developed in the past decades. Initially, these methods were mainly used for research purposes, but they are now increasingly used in clinical practice for assessment of viable cardiac tissue. The key issue is to detect potentially salvageable tissue in jeopardized areas, predominantly pertaining to infarct zones and areas supplied by critically stenosed arteries.1 The correct identification of hibernating and stunned myocardium in patients with severely depressed cardiac function can have vital therapeutic consequences for the patient. Changes in myocardial fatty acid and glucose metabolism during acute and prolonged ischemia can be traced by positron emitting or gamma emitting radiopharmaceuticals. Positron emission tomography (PET) that uses combinations of flow tracers and metabolic tracers offers unique opportunities for quantification and high-resolution static and rapid dynamic studies. Currently, assessment of glucose metabolism with fluorine-18-fluorodeoxyglucose (18FDG) is regarded as the gold standard for myocardial viability and for prediction of improvement of impaired contractile function after revascularization. However, preserved oxidative metabolism may be required for potential functional improvement and therefore, assessment of residual oxidative metabolism by carbon-11(1lC)-acetate PET may prove to be more accurate than 18FDG PET which reflects both anaerobic and oxidative metabolism. Moreover, because fatty acids are metabolized only aerobically, they are excellent candidates for clinical assessment of myocardial viability and prediction of functional improvement after revascularization. Apart from positron emission agents for studying cardiac metabolism, single photon agents have gained renewed interest. In this regard, radioiodinated free fatty acids have been shown to be valuable alternative tracers for studying cardiac metabolism and viability. Especially derivatives of radioiodinated free fatty acids which are not metabolized but accumulate in the myocyte are attractive for myocardial imaging. Examples are 123I-ß-methyl-p-iodophenyl pentadecanoic acid (123I-BMIPPA) and 15-(o-123I-phenyl)-pentadecanoic acid (123I-olPPA). These tracers can be detected by planar scintigraphy and single photon emission computed tomography (SPECT), which are more economical and more widely available techniques than PET. In addition, 511 keV collimators have been developed recently, making the detection of positron emitters by planar scintigraphy and SPECT feasible. The purpose of this chapter is to explore the properties of myocardial metabolism that offer opportunities for imaging and to discuss how different imaging modalities are capable to translate changes in metabolism into clinically useful information.

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Authors
  1. Ernst E. van der Wall
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Editors and Affiliations

  1. Department of Cardiology, University Hospital Leiden, Leiden, The Netherlands

    E. E. van der Wall

  2. Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands

    P. K. Blanksma

  3. Department of Cardiology, Martini Hospital, Groningen, The Netherlands

    M. G. Niemeyer

  4. PET Centre, University Hospital Groningen, Groningen, The Netherlands

    A. M. J. Paans

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© 1995 Springer Science+Business Media Dordrecht

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van der Wall, E.E. (1995). Cardiac Metabolism: Positron Emission Tomography Versus Single Photon Emission Computed Tomography. In: van der Wall, E.E., Blanksma, P.K., Niemeyer, M.G., Paans, A.M.J. (eds) Cardiac Positron Emission Tomography. Developments in Cardiovascular Medicine, vol 166. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-0023-6_5

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  • DOI: https://doi.org/10.1007/978-94-011-0023-6_5

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  • Print ISBN: 978-94-010-4014-3

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