13N-ammonia myocardial blood flow and uptake
Relation to functional outcome of asynergic regions after revascularization
Anastasia N. Kitsiou, MDa,b,
Stephen L. Bacharach, PhDa,b,
Marissa L. Bartlett, PhDa,b,
Gopal Srinivasan, MD, FACCa,b,
Ronald M. Summers, MD, PhDa,b,
Arshed A. Quyyumi, MD, FACCa,b and
Vasken Dilsizian, MD, FACCa,b
a Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
b Department of Nuclear Medicine, National Institutes of Health, Bethesda, Maryland, USA
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Figure 1 Sequence and timing of 13N-ammonia and FDG PET imaging.
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Figure 2 Plots of mean 13N-ammonia absolute myocardial blood flow, late 13N-ammonia uptake, and FDG uptake in asynergic regions that improved (open bars) and those that did not improve (solid bars) after revascularization are shown. Absolute myocardial blood flow, late 13N-ammonia uptake, and FDG uptake are significantly higher in reversible compared to irreversible asynergic regions after revascularization.
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Figure 3 Positive and negative predictive values in assessing recovery of asynergic regions after revascularization are shown in relation to the magnitude of absolute blood flow, late 13N-ammonia uptake, FDG uptake, and thallium uptake (maximum on either redistribution or reinjection). When 13N-ammonia uptake and FDG metabolic data were combined, none of the asynergic regions demonstrating uptake of less than 50% on both 13N-ammonia and FDG images showed improvement in systolic wall thickening after revascularization (negative predictive accuracy of 100%).
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Figure 4 Plots of ROC curves for late 13N-ammonia uptake and absolute blood flow to predict functional improvement after revascularization in asynergic regions. Area under the ROC curve for absolute blood flow and late 13N-ammonia uptake is displayed. Late 13N-ammonia uptake was a significantly better predictor of functional improvement when compared to absolute blood flow.
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Figure 5 Relation between percent late 13N-ammonia uptake and FDG uptake (top) and thallium uptake on redistribution imaging (bottom) in reversible (open circles) and irreversible (closed circles) asynergic regions after revascularization. There is a linear relationship among late 13N-ammonia uptake, FDG uptake, and thallium uptake in all asynergic regions.
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Figure 6 Concordance between 13N-ammonia and FDG uptake is demonstrated in this patient example. Matched transaxial tomograms are displayed for 13N-ammonia uptake and FDG uptake by PET, with corresponding end-diastolic and end-systolic MRI tomograms before (pre-) revascularization (on the left) and after (post-) revascularization (on the right). On the PET study, both 13N-ammonia and FDG uptake are severely reduced in the apical region (matched defect). Corresponding MRI tomograms reveal absent systolic wall thickening in the apical region before revascularization, which remains irreversible after revascularization.
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