Abstract
With this document, we provide a standard for PET/(diagnostic) CT imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is). This standard should be applied in clinical practice and integrated in clinical (multicenter) trials for optimal procedural standardization. A major focus is put on procedures using [18F]FDG, but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this document. Whilst these novel tracers are currently mainly applied in early clinical trials, some multicenter trials are underway and we foresee in the near future their use in clinical care and inclusion in the clinical guidelines. Finally, PET/MR applications in 4Is cardiovascular diseases are also briefly described. Diagnosis and management of 4Is-related cardiovascular diseases are generally complex and often require a multidisciplinary approach by a team of experts. The new standards described herein should be applied when using PET/CT and PET/MR, within a multimodality imaging framework both in clinical practice and in clinical trials for 4Is cardiovascular indications.
Highlights
The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide among individuals pursuing clinical and research excellence in nuclear medicine
PET/CT may be performed without the administration of contrast agent in patients with suspected cardiac amyloidosis or altered myocardial innervation as the accumulation of these tracers is highly specific to the respective imaging target
In order to facilitate the interpretation of [18F]FDG PET images, we suggest classification of the [18F]FDG findings as follow [13, 60, 61]: Typical findings & Presence of focal, heterogenous, valvular/peri-valvular [18F]FDG uptake persisting on non-attenuation corrected (NAC) images and corresponding to an area of suspected infection on echocardiography or CT angiography (CTA)
Summary
The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide among individuals pursuing clinical and research excellence in nuclear medicine. For [68Ga]DOTA-conjugated peptides in the setting of atherosclerosis, acquisition 60 min after administration results in optimal vascular wall activity against blood pool background [3] Similar protocols to those suggested for [18F]NaF, including motion correction and contrast CT coronary angiography (CTA), should be applied for coronary imaging. PET/CT may be performed without the administration of contrast agent in patients with suspected cardiac amyloidosis or altered myocardial innervation as the accumulation of these tracers is highly specific to the respective imaging target. Homogeneous, and low intensity [18F]FDG uptake can be observed in the majority of noninfected vascular graft prostheses shortly after surgery This is related to the body’s response to foreign material, and should be considered to avoid misinterpretation of PET/CT studies in patients referred for suspected prosthetic infection [75]. The challenge of the clinical imager within the 4Is team is to establish a new professional perspective: a new vision of the imager, no longer thinking as an individual, but rather as an integral player and contributor to the team, translating the image content into clinical planning and a decision-making process that enhance the quality of patient care
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