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Myocardial positron emission computed tomographic images obtained with fluorine-18 fluoro-2-deoxyglucose predict the response of idiopathic dilated cardiomyopathy patients to beta-blockers

Shinji Hasegawa, MD, PhD^*,*, Hideo Kusuoka, MD, PhD, FACC, Kaoru Maruyama, MD, PhD^*, Tsunehiko Nishimura, MD, PhD, Masatsugu Hori, MD, PhD, FACC and Jun Hatazawa, MD, PhD^*

^* Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Vice Director General, Osaka National Hospital, Osaka, Japan
Department of Radiology, Graduate School of Medical Science Kyoto Prefectural University of Medicine, Kyoto, Japan
Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan

View larger version (12K): [in a new window]   Figure 1 The one-day, three-acquisition protocol of fluorine-18 fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) for fasting and oral glucose loading. Images after overnight fasting (PET 1) and after oral glucose loading (PET 3) were acquired serially on the same day. The image for subtraction (PET 2) was acquired just before the second injection of FDG.

View larger version (111K): [in a new window]   Figure 2 Typical examples of grading of the histologic findings (hematoxylin-eosin staining x400). (a) No fibrosis, no muscle bundle fragmentation, and no myocyte degeneration (histopathologic contractility failure index = 0). (b) Severe fibrosis but no degenerative change (scores: fibrosis = 3; fragmentation = 3; degeneration = 0). (c) Severe muscle bundle fragmentation but mild degeneration (scores: fibrosis = 2; fragmentation = 3; degeneration = 1). (d) Severe degeneration but no fibrosis (scores: fibrosis = 0; fragmentation = 0; degeneration = 3).

View larger version (14K): [in a new window]   Figure 3 The (global) percent uptake of injected dose per 100 g tissue of fluorine-18 fluoro-2-deoxyglucose after glucose loading (a) and the total defect scores on the myocardial perfusion images (b) of responders and nonresponders. SPECT = single-photon emission computed tomography.

View larger version (15K): [in a new window]   Figure 4 Relation of (global) percent uptake of injected dose per 100 g tissue of fluorine-18 fluoro-2-deoxyglucose on the glucose-loading image (a) and myocardial perfusion single-photon emission computed tomography (SPECT) total defect score (b) to histopathologic contractility failure index as an index of histologic severity.

View larger version (31K): [in a new window]   Figure 5 Relationship between fluorine-18 fluoro-2-deoxyglucose (FDG) uptake pattern and histologic findings. The patients were classified into four groups according to global percent of uptake of injected dose (ID) per 100 g tissue of FDG after glucose loading and total FDG uptake score during fasting. HCFI = histopathologic contractility failure index; OMI = old myocardial infarction.

View larger version (83K): [in a new window]   Figure 6 Vertical long-axis images in two cases of different types. The patient on the left side showed low fluorine-18 fluoro-2-deoxyglucose (FDG) uptake both during fasting (a) (total uptake score = 0) and after glucose loading (b) (global percent uptake of injected dose per 100 g tissue [G%ID] 0.36%), and a low myocardial perfusion defect score (c) (total defect score = 11). This patient had severe fibrosis (Fig. 7a), and the left ventricular ejection fraction did not improve after ß-blocker therapy (from 0.20 to 0.20). The patient on the right side had high FDG uptake both during fasting (d) (total uptake score = 47) and after glucose loading (e) (G%ID 0.96%). Myocardial perfusion was also maintained (f) (total defect score = 13). Although dilation of the left ventricle was severe, the left ventricular ejection fraction was improved by the ß-blocker (from 0.18 to 0.56) to the point where the patient became symptom-free. Histologic examination revealed severe myocyte degeneration and little fibrosis (Fig. 7b). SPECT = single-photon emission computed tomography.

View larger version (82K): [in a new window]   Figure 7 Histologic findings in the cases in Figures 6a to 6f, and 8. (a) Severe fibrosis and moderate degeneration. (b) No fibrosis and severe degeneration. (c) Severe fibrosis and mild degeneration (original magnification x400).

View larger version (88K): [in a new window]   Figure 8 This patient had high fluorine-18 fluoro-2-deoxyglucose (FDG) uptake during fasting (a to c) (total uptake score = 33) and a broad, severely reduced region in the lateral wall on the glucose-loading image (d to f) (global percent uptake of injected dose per 100 g tissue 0.54). The findings on the perfusion single-photon emission computed tomography (SPECT) image (g to i) (total defect score = 35) were similar to those on the FDG-positron emission tomography image after glucose loading. Histologic analysis revealed severe fibrosis (Fig. 7c). The patient died of heart failure.