Metabolic Scar Assessment with¹⁸F-FDG PET: Correlation to Ischemic Ventricular Tachycardia Substrate and Successful Ablation Sites

Workflow of ¹⁸F-FDG reconstructions. (A) Raw ¹⁸F-FDG PET DICOM showing left ventricle with central region of interest (purple). (B) Resulting 3D LV (purple) and right ventricle (blue) reconstruction. (C) Same slice as shown in A, with color map according to value of ¹⁸F-FDG uptake in each segment, showing decreased uptake in inferolateral scar area. (D) Generated 3D color PET reconstruction from short-axis slices with inferolateral scar based on ¹⁸F-FDG uptake percentage.

Metabolic channel. (A) EAM showing inferior scar with 0.5- to 1.5-mV setting and VT channel or exit site (white point and arrow). (B) Corresponding PET 3D reconstruction showing metabolic channel (dashed lines). (C) Coregistration of EAM and PET 3D reconstruction showing VT channel or exit (arrow) within metabolic channel (dashed lines). Additional example is shown in supplemental materials.

RTA. (A) EAM showing apical and inferior scars with 0.5- to 1.5-mV setting and VT channel or exit site (white point and arrow). (B) PET 3D reconstruction demonstrating RTA (circle, change of ≥50% uptake/15 mm [red to blue color shift]). (C) Coregistration showing VT channel or exit within RTA; arrow points to VT channel or exit site within RTA (circle). Additional example is shown in supplemental materials.

MVM. (A) EAM showing apical and inferior scars with 0.5- to 1.5-mV setting and VT channel or exit site (white point and arrow). (B) PET 3D reconstruction demonstrating larger severe PET defect (red area = MVM). (C) Coregistration of 3D PET reconstruction and EAM demonstrating VT channel or exit within MVM (arrow). Additional example is shown in supplemental materials.