PET imaging of the autonomic myocardial function: methods and interpretation

Abstract

Cardiac positron emission tomography (PET) is mainly applied in myocardial perfusion and viability detection. Noninvasive imaging of myocardial innervation using PET is a valuable additional methodology in cardiac imaging. Novel methods and different PET ligands have been developed to measure presynaptic and postsynaptic function of the cardiac neuronal system. Obtained PET data can be analysed quantitatively or interpreted qualitatively. Thus far, PET is not a widely used clinical application in autonomic heart imaging; however, due to its technical advantages, the excellent properties of the imaging agents, and the availability of tools for quantification, it deserves a better position in the clinic. From a historical point of view, the focus of PET software packages for image analysis was mainly oncology and neurology driven. Actually, commercially available software for cardiac PET image analysis is still only available for the quantification of myocardial blood flow. Thus far, no commercial software package is available for the interpretation and quantification of PET innervation scans. However, image data quantification and analysis of kinetic data can be performed using adjusted generic tools. This paper gives an overview of different neuronal PET ligands, interpretation and quantification of acquired PET data.

The autonomic nervous system as a therapeutic target in heart failure: a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology

“…Imaging by PET achieves higher temporal and spatial resolution than SPECT and has the added benefit of allowing absolute quantification of pre‐ and post‐synaptic sympathetic innervation . Recently, 11 C‐metahydroxyphedrine PET was successfully applied to quantify the inhomogeneity in myocardial sympathetic innervation to identify patients at risk for sudden cardiac death .…”

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

“…For amyloidosis and innervation imaging with specific tracers such as [ 1 8 F]florbetaben, [ 1 8 F]florbetapir, [ 18 F]flutemetamol, [ 11 C]PiB, and [ 11 C]mHED respectively, a dynamic scan starting simultaneously with tracer injection covering the heart has to be performed covering the heart starting simultaneously with radiopharmaceutical injection, followed by a static image reconstruction (Table 1) (39,40). Acquisition should be in list mode, or, if list mode is not available, should be done as a dynamic scan with framing that allows for calculation of the retention index (see later) at the desired interval.…”

“…( 5 ); [ 11 C]mHED: 0–60 min p.i. ( 39 , 40 ). Acquisition should be in list mode, or, if list mode is not available, should be done as a dynamic scan with framing that allows for calculation of the retention index (see later) at the desired interval.…”