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Updated: Aug 10, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
A report system for PET assessment of myocardial viability
R Lorenzoni1, D Pagano, H Boyd
1MRC Cyclotron Unit, Hammersmith Hospital, London, UK.
Insights
This study introduces a new PET imaging system to precisely evaluate myocardial viability in heart failure patients. It improves risk assessment for coronary bypass surgery by matching PET viability data with echocardiography wall motion analysis.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Coronary artery disease (CAD) patients with heart failure may benefit from bypass surgery.
- High operative risk necessitates accurate assessment of viable myocardium (asynergic myocardium) for functional recovery post-revascularization.
- Current methods like echocardiography and PET imaging for assessing wall motion and metabolic activity often yield conflicting results, complicating risk-benefit analysis.
Purpose of the Study:
- To present a novel reporting system for evaluating myocardial viability using positron emission tomography (PET).
- To enable precise matching of regional wall motion data from echocardiography with PET-derived viability information.
- To improve the reliability of risk-benefit estimations for coronary bypass surgery in CAD patients.
Main Methods:
- The left ventricle was divided into 16 standardized segments, aligning with the American Society of Echocardiography's recommendations for wall motion analysis.
- A standardized partition was applied to short-axis PET images, dividing the basal and mid-ventricular portions into six segments each, and the apical portion into four segments.
- This segmentation strategy facilitates direct comparison between echocardiography-based wall motion assessment and PET-based metabolic viability data.
Main Results:
- The proposed segmentation system allows for a detailed, segment-by-segment comparison of myocardial viability and function.
- This precise matching overcomes discrepancies between echocardiography and PET findings.
- The system enhances the accuracy of determining the amount of viable myocardium, crucial for surgical decision-making.
Conclusions:
- The developed PET reporting system provides a standardized method for evaluating myocardial viability.
- It enables accurate correlation of PET viability data with echocardiographic wall motion analysis.
- This improved assessment aids in better patient selection and risk stratification for coronary bypass surgery in heart failure patients with CAD.
Abstract:
Coronary bypass surgery can improve the prognosis of patients with heart failure due to coronary artery disease. However, these patients have a high operative risk and should be operated on only if they have a sizeable amount of viable tissue (i.e. asynergic myocardium) that can recover contractile function following coronary revascularization. In the clinical setting, regional wall motion is usually evaluated by two-dimensional echocardiography, whereas retained metabolic activity assessed by positron emission tomography (PET) and 18F-fluorodeoxyglucose is a well-established means for the evaluation of myocardial viability. Unfortunately, the two-dimensional echocardiography and PET reports are often different, and this renders the matching of information difficult and the estimation of the risk-benefit ratio of the operation unreliable. In this paper, we present a report system for the evaluation of myocardial viability with PET. We divided the left ventricle into 16 segments following the proposal of the American Society of Echocardiography for wall motion analysis by two-dimensional echocardiography. Following this partition, three portions of the left ventricle are identified along the long axis: basal, mid and apical. Each plane of the basal and mid portions is automatically divided into six segments with the super-imposition of a radial divider over the short-axis images. Similarly, each plane of the apical portion is automatically divided, but into four segments. This partition of the left ventricle permits a precise match between the information on wall motion obtained with two-dimensional echocardiography and that on viability obtained with PET.
