Cardiac PET/MRI

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The introduction of Simultaneous PET/MR into the diagnostic armamentarium of cardiac imaging brings two well-established modalities for myocardial viability assessment together as a single examination and has the potential to make viability imaging, which is so relevant in CAD management, more robust. The feasibility of simultaneous acquisition of cardiac PET and MRI data using Biograph mMR has been established in recent studies (Christoph Rischpler et. al.). Though PET/MRI role in CAD patients with LV dysfunction looks promising, clinical outcome data are needed to prove that image-guided and individualized vascular medicine with PET/MRI technology leads to an improved clinical outcome and prognosis in high-risk patients.

Several recent studies have tried to investigate whether hybrid FDG PET/MR imaging of myocardial infarction can provide additional information compared with MR imaging or PET alone PET/MRI is likely to become the gold standard in determining the potential in the recovery of cardiac function in ischemic jeopardized but viable myocardium in heart failure patients. Integrated with MR imaging techniques for the detection of myocardial edema, motion, or perfusion deficits, this method could provide insights into the mechanisms of post-infarction remodeling.

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Case 1: Follow Up Case of Tubercular Myocarditis

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Case History:

20 year old female being treated for myocarditis. On ATT. Was referred for Cardiac PET/ MRI for follow up evaluation. Two PET/CT had been performed at earlier instances on 19/12/14 and 5/8/14 respectively and were available for comparison.

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Findings:

Cardiac PET/MRI revealed dilated Left ventricle with evidence of global hypokinetic movement of its walls prominent in the interventricular septum which appeared thinned out. There is evidence of ill-defined T2 hyperintensity in the cardiac apex with corresponding mild FDG uptake on fused PET/MR image( SUV max: 1.51) Delayed post-contrast PSIR images reveal diffuse enhancement of the IV septum and the posterior ventricular wall with no abnormal FDG uptake.

Short axis T2 cine images (A, B, C) showing left ventricular wall in the end-diastole (A) and systole(B) phases.

Short axis PSIR (post-contrast inversion recovery ) sequence showing mild diffuse IVS enhancement (A and B, arrows) (C) T2 STIR long axis showing an area of altered intensity in the LV apex (arrow) showing corresponding increased focal FDG uptake suggesting residual changes in fused PET/MR image(D, long arrow).

Previous PET/CT dated 5/8/14 (A, B, C) revealed increased FDG uptake along the left ventricular walls (arrows) which showed regression in the follow-up PET/CT dated 19/12/14 (D, E, F) with residual uptake in the IVS ( arrow).

Simultaneous whole-body PET/MR provides better delineation of cardiac anatomy with simultaneous functional and metabolic information in a single study.

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Case Study Prepared by:

This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).

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Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.

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