Abstract
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Introduction: Spontaneous coronary artery dissection (SCAD) can be a diagnostic challenge and may be missed with coronary angiography alone. We propose a novel application of 18F-FDG/PET to identify inflammation in cases of suspected SCAD. Though 18FDG/PET cannot differentiate SCAD from other causes of myocardial inflammation, we suggest it may localize inflammation in cases where a culprit artery is not obvious on invasive angiography.
Methods: Participants with clinically significant myocardial injury as measured by troponin I ≥ 5 ng/mL were enrolled and underwent invasive coronary angiography. All participants gave informed consent in accordance with the Institutional Review Board of Johns Hopkins Hospital. Following invasive angiography, patients with SCAD diagnosed by angiography also underwent 18F-FDG/PET scan and transthoracic echocardiogram within 48-72 hours of hospital admission. Participants received a low-carbohydrate diet on the day before imaging followed by a 12-hour fast to optimize glucose uptake. The FDG/PET scan was performed on all participants, and scans were analyzed to localize inflammation by coronary artery distribution.
Results: Four subjects with SCAD were enrolled in the study and underwent 18F-FDG/PET. The PET reconstructed images were compared to the invasive coronary angiogram and transthoracic echocardiogram. The participants had marked inflammation in the territories that correlated with invasive angiography and echocardiography
Results: An example case is presented in the Figure. Conclusion: A novel application of 18F-FDG PET identifies myocardial inflammation in cases of suspected SCAD.
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