The Role of PET with 13N-Ammonia and 18F-FDG in the Assessment of Myocardial Perfusion and Metabolism in Patients with Recent AMI and Intracoronary Stem Cell Injection

Massimo Castellani; Alessandro Colombo; Rosaria Giordano; Enrico Pusineri; Cristina Canzi; Virgilio Longari; Emanuela Piccaluga; Simone Palatresi; Luca Dellavedova; Davide Soligo; Paolo Rebulla; Paolo Gerundini

doi:10.2967/jnumed.110.078469

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FIGURE 1.
Example polar maps showing distribution of ¹³N-ammonia (A) and ¹⁸F-FDG (B) in left ventricle. ¹³N-ammonia percentage uptake within 1.0 SD or lower than −4.5 SDs from maximum defines normally perfused segment (green) or scarred segment (red). Normal or scarred segments may also be characterized by ¹³N-ammonia uptake between −1.0 and −2.5 SDs and between −2.5 and −4.5 SDs, respectively, both combined with differential ¹⁸F-FDG uptake less than 15%. ¹³N-ammonia uptake levels between −1.0 and −4.5 SDs and differential ¹⁸F-FDG uptake greater than 15% define viable segment (blue).
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FIGURE 2.
Comparison among MBF values in normal, viable, and scarred segments of all patients enrolled in study and MBF values in control segments of reference database.
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FIGURE 3.
¹³N-ammonia serial images and polar maps of 2 patients of groups A and B. (A) Shrinkage of perfusion defect in patient 3 at 3 mo after injection of bone marrow–derived cells. (B) Enlargement of perfusion defect in patient 9, who had in-stent chronic occlusion between 3 and 6 mo after therapy with peripheral blood–derived cells. Relative decrease in ammonia uptake is consistent with reduction of MBF also in non–infarct-related areas.
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FIGURE 4.
Mean percentage variation in infarct size and MBF in patients of the 3 groups during follow-up.
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FIGURE 5.
Mean percentage variation in LVEF and end-diastolic volume in patients of the 3 groups during follow-up.

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TABLE 1

Semiquantitative Analysis of Myocardial Damage

	Baseline			3 mo			6 mo			12 mo
Patient no.	Abnormal segments^*	Infarct size^{^†}	Viable area^{^†}	Abnormal segments	Infarct size	Viable area	Abnormal segments	Infarct size	Viable area	Abnormal segments	Infarct size	Viable area
Group A
1	4 (1)	0.49	0.04	3 (0)	0.30	—	3 (0)	0.33	—	3 (0)	0.30	—
2	3 (1)	0.47	0.06	3 (0)	0.41	—	3 (0)	0.45	—	3 (0)	0.45	—
3	7 (0)	0.76	—	4 (1)	0.47	0.06	3 (0)	0.49	—	3 (0)	0.41	—
4	3 (0)	0.49	—	3 (0)	0.47	—	3 (0)	0.45	—	3 (0)	0.41	—
5	4 (0)	0.45	0.04	5 (2)	0.41	0.19	4 (1)	0.32	0.17	2 (0)	0.22	—
Mean ± SD	4.2 ± 1.6	0.53 ± 0.13	0.03 ± 0.03	3.6 ± 0.9	0.41 ± 0.07	0.05 ± 0.08	3.2 ± 0.4	0.41 ± 0.08	0.03 ± 0.08	2.8 ± 0.4	0.36 ± 0.10	0.00 ± 0.00
Group B
6^‡	4 (0)	0.53	0.04	5 (2)	0.57	0.16	—	—	—	—	—	—
7	5 (3)	0.35	0.18	3 (0)	0.49	—	4 (0)	0.49	—	4 (0)	0.45	0.04
8	5 (0)	0.57	—	5 (0)	0.57	—	6 (1)	0.57	0.04	5 (0)	0.45	—
9^‡	4 (0)	0.57	—	6 (2)	0.41	0.16	4 (0)	0.53	—	—	—	—
10	5 (0)	0.65	—	3 (0)	0.61	—	6 (1)	0.57	0.04	4 (0)	0.64	—
Mean ± SD	4.6 ± 0.5	0.53 ± 0.11	0.04 ± 0.08	4.4 ± 1.3	0.53 ± 0.08	0.06 ± 0.09	5.0 ± 1.1	0.54 ± 0.04	0.02 ± 0.02	4.2 ± 0.4	0.51 ± 0.11	0.00 ± 0.02
Group C
11	2 (0)	0.30	—	6 (2)	0.41	0.12	3 (1)	0.26	0.08	3 (1)	0.22	0.08
12	5 (4)	0.12	0.49	3 (2)	0.16	0.37	5 (2)	0.24	0.25	2 (1)	0.18	0.15
13	4 (0)	0.41	—	4 (0)	0.37	—	3 (0)	0.30	—	3 (0)	0.33	—
14	3 (0)	0.41	—	4 (0)	0.49	—	4 (0)	0.46	—	4 (0)	0.41	—
15^‡	5 (0)	0.76	—	6 (1)	0.76	0.04	6 (2)	0.57	0.16	—	—	—
Mean ± SD	3.8 ± 1.3	0.40 ± 0.23	0.10 ± 0.22	4.6 ± 1.3	0.46 ± 0.25	0.10 ± 0.15	4.2 ± 1.3	0.37 ± 0.14	0.09 ± 0.11	3.0 ± 0.8	0.28 ± 0.10	0.05 ± 0.07

↵* Number of scarred plus viable segments (viable segments in parentheses).
↵† Infarct size and viable area are expressed as percentage of total polar map area.
↵‡ Patients excluded from study during follow-up due to reocclusion (patients 6 and 9) or cardiac transplantation (patient 15).

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TABLE 2

Quantitative Analysis of MBF in Infarcted and Noninfarcted Areas

	MBF (mL/min/g) at…
	Baseline		3 mo		6 mo		12 mo
Patient no.	Infarcted area	Noninfarcted area	Infarcted area	Noninfarcted area	Infarcted area	Noninfarcted area	Infarcted area	Noninfarcted area
Group A
1	0.514	0.779	0.470	0.833	0.538	0.822	0.623	0.855
2	0.531	0.921	0.544	0.909	0.513	0.783	0.583	0.801
3	0.502	0.904	0.544	0.791	0.630	0.930	0.824	1.256
4	0.399	0.856	0.410	0.934	0.425	1.016	0.573	1.019
5	0.399	0.517	0.492	0.668	0.452	0.563	0.460	0.496
Mean ± SD	0.47 ± 0.06	0.80 ± 0.17	0.49 ± 0.06	0.83 ± 0.11	0.51 ± 0.08	0.82 ± 0.17	0.61 ± 0.13	0.89 ± 0.28
Group B
6^*	0.374	0.885	0.398	0.827	—	—	—	—
7	0.432	0.806	0.397	0.730	0.351	0.591	0.336	0.685
8	0.432	0.781	0.400	0.680	0.340	0.629	0.311	0.626
9^*	0.556	0.881	0.503	0.756	0.396	0.642	—	—
10	0.416	0.814	0.335	0.522	0.334	0.534	0.399	0.681
Mean ± SD	0.44 ± 0.07	0.83 ± 0.05	0.41 ± 0.06	0.70 ± 0.11	0.36 ± 0.03	0.60 ± 0.05	0.35 ± 0.05	0.66 ± 0.03
Group C
11	0.552	0.805	0.418	0.761	0.539	0.875	0.514	0.731
12	0.577	0.845	0.587	0.870	0.566	0.677	0.770	0.974
13	0.619	0.925	0.602	0.860	0.557	0.878	0.488	0.766
14	0.490	1.022	0.407	0.812	0.453	0.800	0.448	0.738
15^*	0.424	0.629	0.428	0.848	0.440	0.667	—	—
Mean ± SD	0.53 ± 0.08	0.85 ± 0.15	0.49 ± 0.10	0.83 ± 0.04	0.51 ± 0.06	0.78 ± 0.10	0.56 ± 0.15	0.80 ± 0.12