Cardiac imaging with 18F-fluorodeoxyglucose PET/MRI in hypertrophic cardiomyopathy
18 Cardiac imaging with F-fluorodeoxyglucose PET/MRI in hypertrophic cardiomyopathy
Yasuchika Takeishi 0 2
Atsuro Masuda 0 2
Hitoshi Kubo 0 1
Hideyuki Tominaga 0 1
Noboru Oriuchi 0 1
Seiichi Takenoshita 0
PhD 0 1
0 Electronic supplementary material The online version of this article (doi:10.1007/s12350-016-0686-x) contains supplementary material , which is available to authorized users. Reprint requests: Yasuchika Takeishi, MD, PhD , Department of Car- diovascular Medicine, Fukushima Medical University , 1 Hikarigaoka, Fukushima 960-1295 , Japan
1 Advanced Clinical Research Center, Fukushima Medical University , Fukushima , Japan
2 Department of Cardiovascular Medicine, Fukushima Medical University , Fukushima , Japan
Simultaneous imaging with magnetic resonance
imaging (MRI) and positron emission tomography
(PET) is valuable in various cardiac diseases.1,2 Altered
myocardial metabolism has been reported in
hypertrophic cardiomyopathy (HCM).3 In this study, we
report an instructive case of HCM with intense
18Ffluorodeoxyglucose (FDG) uptake in the hypertrophied
myocardium detected by PET/MRI.
A 57-year-old female was referred to our hospital
for severe left ventricular hypertrophy (LVH). Although
she had no symptoms and no history of hypertension,
echocardiography demonstrated severe LVH in the mid
LV to the apex with no asymmetric septal hypertrophy.
Thus, we suspected apical type of HCM and performed
FDG-PET/MRI. After fasting for more than 18 hours,
the patient was administered unfractionated heparin 50
IU/kg intravenously 15 minutes before FDG
administration to suppress physiological FDG uptake on the
myocardium.2 Image acquisition was initiated 60 min
after FDG administration. Cine MRI images (Videos 1
and 2 in supplementary material) showed severe
hypertrophy in the middle region of the LV with no LV
outflow obstruction. However, myocardial thinning and
reduced wall motion were observed in the apex. Intense
FDG uptake was observed in the LV, suggesting a
metabolic substrate switching from fatty acids to
glucose, and FDG uptake was relatively low, and late
gadolinium enhancement was evident in the apex
(Figures 1, 2). Fusion images clearly showed FDG
uptake on the hypertrophied myocardium. It should be
noted that, although we used prolonged fasting and
intravenous heparin, distinguishing physiological uptake
of FDG from pathological uptake related to metabolic
switching might be sometimes challenging.
Simultaneous PET/MRI was able to reconstruct accurate fusion
images and provided anatomic and metabolic
characterizations of the hypertrophied heart. Myocardial biopsy
revealed cardiomyocyte hypertrophy with mere disarray,
slight fibrosis, and no inflammatory cell infiltration,
consistent with pathological findings of HCM. There
were no signs suggestive of secondary cardiomyopathy,
which represents cardiac hypertrophy. The PET/MRI is
a novel useful imaging technology to evaluate structural
and functional abnormalities in HCM.
FDG was supplied by Nihon Medi-Physics Co., Ltd.
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1. Rischpler C , Nekolla SG , Kunze KP , Schwaiger M. PET/MRI of the heart . Semin Nucl Med . 2015 ; 45 : 234 - 47 .
2. Wada K , Niitsuma T , Yamaki T , Masuda A , Ito H , Kubo H , Hara T , Takenoshita S , Takeishi Y. Simultaneous cardiac imaging to detect inflammation and scar tissue with 18F-fluorodeoxyglucose PET/ MRI in cardiac sarcoidosis . J Nucl Cardiol . 2016 ; 23 : 1180 - 2 .
3. Tadamura E , Tamaki N , Matsumori A , Magata Y , Yonekura Y , Nohara R , et al. Myocardial metabolic changes in hypertrophic cardiomyopathy . J Nucl Med . 1996 ; 37 : 572 - 7 .