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CLINICAL STUDY: CARDIOVASCULAR IMAGING

Myocardial perfusion and viability by positron emission tomography in infants and children with coronary abnormalities

correlation with echocardiography,coronary angiography, and histopathology

Miguel Hernandez-Pampaloni, MD, PhD,^*, Vivekanand Allada, MD, Michael C. Fishbein, MD and Heinrich R. Schelbert, MD, PhD^*,*

^* Molecular and Medical Pharmacology David Geffen School of Medicine at UCLA, University of California at Los Angeles,Los Angeles, California, USA
Pediatrics, David Geffen School of Medicine at UCLA, University of California at Los Angeles,Los Angeles, California, USA
Pathology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California, USA

Manuscript received May 19, 2002; revised manuscript received August 2, 2002, accepted August 26, 2002.

^* Reprint requests and correspondence: Dr. Heinrich R. Schelbert, Department of Molecular and Medical Pharmacology, 23-120 CHS, Box 173517, Los Angeles, California 90095-6948, USA.
hschelbert{at}mednet.ucla.edu

OBJECTIVES: This study was designed to assess the feasibility and accuracy of positron emission tomography (PET) imaging in infants and children.

BACKGROUND: Positron emission tomography is employed in adults for the evaluation of myocardial perfusion and the detection of myocardial viability.

METHODS: Perfusion and metabolism findings on PET in infants and children with suspected coronary abnormalities (age 14 days to 12 years old, mean 3.3 ± 4.0 years) were correlated with findings on coronary angiography, echocardiography, and myocardial histopathology. The segmental myocardial uptake of the flow tracer ¹³N-ammonia and of the glucose tracer ¹⁸F-deoxyglucose (¹⁸FDG) was graded on a five-point scale and compared with the angiographic perfusion score, with regional wall motion, and the presence of fibrosis.

RESULTS: There was an agreement of r = 0.72 (p < 0.05) between regional myocardial perfusion and angiography. The correlation of histopathologic changes with normal, moderately, and severely reduced segmental ¹³N-ammonia uptake was 87%, 60%, and 75%, respectively. Segmental myocardial ¹⁸FDG uptake and histopathologic findings were concordant in 48 (79%) of 64 segments without fibrosis; absence of viability by perfusion and metabolism imaging correlated with the presence of fibrosis in 21 (84%) of 25 segments.

CONCLUSIONS: The observed agreements between the findings on PET perfusion and metabolism imaging with those on coronary angiography, echocardiography, and histopathology support the utility and accuracy of PET for characterizing myocardial perfusion abnormalities and viability in pediatric patients.

Abbreviations and Acronyms   18FDG   18F-deoxyglucose   ANOVA   analysis of variance   IV   intravenous   LAD   left anterior descending artery   LCX   left circumflex coronary artery   LV   left ventricular   PET   positron emission tomography   RCA   right coronary artery   ROI   region of interest

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