title: Quantifying the Area at Risk in Reperfused ST-Segment-Elevation Myocardial Infarction Patients Using Hybrid Cardiac Positron Emission Tomography-Magnetic Resonance Imaging.
abstract: BACKGROUND
  Hybrid positron emission tomography and magnetic resonance allows the advantages of magnetic resonance in tissue characterizing the myocardium to be combined with the unique metabolic insights of positron emission tomography. We hypothesized that the area of reduced myocardial glucose uptake would closely match the area at risk delineated by T2 mapping in ST-segment-elevation myocardial infarction patients.
  
  
  RESULTS
  Hybrid positron emission tomography and magnetic resonance using (18)F-fluorodeoxyglucose (FDG) for glucose uptake was performed in 21 ST-segment-elevation myocardial infarction patients at a median of 5 days. Follow-up scans were performed in a subset of patients 12 months later. The area of reduced FDG uptake was significantly larger than the infarct size quantified by late gadolinium enhancement (37.2±11.6% versus 22.3±11.7%; P<0.001) and closely matched the area at risk by T2 mapping (37.2±11.6% versus 36.3±12.2%; P=0.10, R=0.98, bias 0.9±4.4%). On the follow-up scans, the area of reduced FDG uptake was significantly smaller in size when compared with the acute scans (19.5 [6.3%-31.8%] versus 44.0 [21.3%-55.3%]; P=0.002) and closely correlated with the areas of late gadolinium enhancement (R 0.98) with a small bias of 2.0±5.6%. An FDG uptake of ≥45% on the acute scans could predict viable myocardium on the follow-up scan. Both transmural extent of late gadolinium enhancement and FDG uptake on the acute scan performed equally well to predict segmental wall motion recovery.
  
  
  CONCLUSIONS
  Hybrid positron emission tomography and magnetic resonance in the reperfused ST-segment-elevation myocardial infarction patients showed reduced myocardial glucose uptake within the area at risk and closely matched the area at risk delineated by T2 mapping. FDG uptake, as well as transmural extent of late gadolinium enhancement, acutely can identify viable myocardial segments.
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Heerajnarain
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.). stevenkwhite@gmail.com.
authors.forename: Steven K
authors.initials: SK
authors.lastname: White
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Georg M
authors.initials: GM
authors.lastname: Fröhlich
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Steven G
authors.initials: SG
authors.lastname: Casson
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Celia
authors.initials: C
authors.lastname: O'Meara
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Ayla
authors.initials: A
authors.lastname: Newton
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nicholas
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Peter
authors.initials: P
authors.lastname: Weale
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Simon M Y
authors.initials: SM
authors.lastname: Wan
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Alex
authors.initials: A
authors.lastname: Sirker
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Ashley
authors.initials: A
authors.lastname: Groves
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Leon
authors.initials: L
authors.lastname: Menezes
authors.affiliation: From the The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK (H.B., S.K.W., G.M.F., A.N., D.M.Y., D.J.H.); The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, UK (H.B., S.K.W., A.S., J.C.M., D.M.Y., D.J.H.); Independent Researcher (S.G.C.); UCL Institute of Nuclear Medicine, University College London Hospital, UK (C.O., S.M.Y.W., A.G., L.M.); London School Hygiene and Tropical Medicine, London, UK (J.N.); Siemens Healthcare, Frimley, UK (P.W.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.); and National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
mesh_terms: D000368:Aged; D003287:Contrast Media; D003326:Coronary Circulation; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006571:Heterocyclic Compounds; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D009942:Organometallic Compounds; D062645:Percutaneous Coronary Intervention; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000378:metabolism; D020127:Recovery of Function; D013997:Time Factors; D014022:Tissue Survival; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate
keywords: F-flurodeoxyglucose; ST-segment–elevation myocardial infarction; T2 mapping; area at risk; cardiovascular magnetic resonance imaging; hybrid PET-MR imaging; infarct size; positron emission tomography; viability