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Increased [¹⁸F]Fluorodeoxyglucose Accumulation in Right Ventricular Free Wall in Patients With Pulmonary Hypertension and the Effect of Epoprostenol

Minako Oikawa, MD^_*, Yutaka Kagaya, MD, PhD^_*,_*, Hiroki Otani, MD, PhD^_*, Masahito Sakuma, MD, PhD^_*, Jun Demachi, MD^_*, Jun Suzuki, MD, PhD^_*, Tohru Takahashi, MD, PhD^_*, Jun Nawata, MD, PhD^_*, Tatsuo Ido, PhD, Jun Watanabe, MD, PhD^_* and Kunio Shirato, MD, PhD^_*

^_* Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan

View larger version (65K): [in a new window]   Figure 1 The midventricular transaxial [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) images of the patients with mild (A, mean pulmonary artery pressure, 33 mm Hg) and severe pulmonary hypertension (B, mean pulmonary artery pressure, 81 mm Hg). In each image, the right ventricular (RV) free wall is at upper left, the interventricular septum at middle, and the left ventricular (LV) free wall at lower right. In the patients with severe pulmonary hypertension, the RV FDG accumulation increased compared with that in the patients with mild pulmonary hypertension. The RV standardized uptake value of FDG corrected for the partial volume effect was 6.6 and 12.7 in the patients with mild and severe pulmonary hypertension, respectively.

View larger version (32K): [in a new window]   Figure 2 Correlations between the right ventricular (RV) standardized uptake value (SUV) of [18F]fluorodeoxyglucose (FDG) corrected for the partial volume effect and mean pulmonary artery pressure (A), right atrial pressure (B), pulmonary vascular resistance (C), wall stress in the RV free wall (D), and plasma brain natriuretic peptide (BNP) level (E).

View larger version (18K): [in a new window]   Figure 3 Correlations between the RV wall thickness and the RV SUV of FDG when not corrected for the partial volume effect (A) and the RV SUV of FDG corrected for the partial volume effect (B). Abbreviations as in Figures 1 and 2.

View larger version (17K): [in a new window]   Figure 4 The RV end-diastolic volume index (RVEDVI) (A) and RV end-systolic volume index (RVESVI) (B) determined by perfusion and function analysis for gated SPECT software (pFAST) were closely correlated with those determined by electron-beam computed tomography (EBCT) or magnetic resonance imaging (MRI), although pFAST analysis was impossible in three patients because their FDG accumulation in the RV free wall was too low. The correlation between the RV ejection fraction (RVEF) (C) determined by pFAST and that by EBCT or MRI was weaker. Other abbreviations as in Figures 1 and 2.

View larger version (66K): [in a new window]   Figure 5 Representative midventricular transaxial FDG PET images of a patient with primary pulmonary hypertension before and after the pulmonary vasodilator therapy with epoprostenol for three months. Before the pulmonary vasodilator therapy, the RV FDG accumulation was highly increased and the corrected RV SUV of FDG was 13.4 (A). After the therapy, the corrected RV SUV of FDG markedly decreased to 7.5 (B). Abbreviations as in Figures 1 and 2.

View larger version (20K): [in a new window]   Figure 6 Correlations between the percentage change of RV SUV of FDG corrected for the partial volume effect and the percentage change of the pulmonary vascular resistance and peak-systolic wall stress in the RV free wall. Abbreviations as in Figures 1 and 2.