Viability assessment by 18F-FDG PET
in a patient with a large left ventricularaneurysm and obstructive coronary arterydiseaseEigo Kurebayashi, Osamu Manabe,
Masanao Naya, Shiro Miura, Takehiro
Yamashita, Yoshihiro Imai, Akira Ando,
Chihoko Miyazaki, et al.
Journal of Nuclear Cardiology
ISSN 1071-3581
J. Nucl. Cardiol.
DOI 10.1007/s12350-018-1443-0

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1 23Author's personal copy
IMAGES THAT TEACH
Viability assessment by 18F-FDG PET in a patientwith a large left ventricular aneurysm
and obstructive coronary artery disease
Eigo Kurebayashi, MD,a Osamu Manabe, MD, PhD,b Masanao Naya, MD, PhD,cShiro Miura, MD,a Takehiro Yamashita, MD, PhD,a Yoshihiro Imai, MD,aAkira Ando, CNMT,a Chihoko Miyazaki, MD, PhD,a and Toshihisa Anzai, MD,PhDc
abc

Hokkaido Ohno Memorial Hospital, Sapporo, Japan
Department of Nuclear Medicine, Hokkaido University of Graduate School of Medicine,Sapporo, Japan
Department of Cardiovascular Medicine, Hokkaido, University Graduate School of Medicine,
Sapporo, Japan

Received Aug 16, 2018; accepted Aug 17, 2018
doi:10.1007/s12350-018-1443-0

An 80-year-old man was referred for the assessmentof myocardial viability 1 month after anterior myocardial infarction. The electrocardiogram showed ST
elevation and pathological Q wave in the anterior precordial
leads(Figure 1).
The2-dimensional
echocardiogram (2DE) revealed a large antero-apicalaneurysm and reduced left ventricular ejection fraction(LVEF) of 42% (Figure 2).
The stress/rest 13N-NH3 PET/CT images showed asevere and large perfusion defect the stress, which waspartially reversible. (Figure 3). The estimated myocardial flow reserve (stress myocardial blood flow (MBF)/rest MBF) was 1.19 in the left anterior descending artery(LAD) territory and 1.44 for global left ventricle.

Reprint requests: Masanao Naya, MD, PhD, Department of Cardiovascular Medicine, Hokkaido University Graduate School ofMedicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan;
naya@med.hokudai.ac.jp
J Nucl Cardiol
1071-3581/$34.00Copyright Ó 2018 American Society of Nuclear Cardiology.

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F-FDG PET/CT with 50 g oral glucose showed
considerable uptake in the region with LV aneurysm,indicating the presence of viable myocardial (Figure 3).
Invasive coronary angiography revealed a 99%
stenosis in the mid-LAD artery with collateral filling.
Successful reperfusion was achieved by balloon angioplasty and a drug-eluting stent (Figure 4).
There was improvement in LV wall motion by 2DE
at 6-month after PCI (Figure 5).
18
F-FDG is an analog of glucose used in theassessment of myocardial viability.1 A region withpreserved 18F-FDG uptake but reduced myocardial
perfusion indicates viable myocardium and is associatedAuthor's personal copy
Kurebayashi et al
Viability assessment by 18F-FDG PETJournal of Nuclear CardiologyÒ

Figure 1. The electrocardiogram showing ST elevation and pathological Q wave in the anteriorprecordial leads.

Figure 2. 2-dimensaional echocardiography showing a large LV aneurysm. End-systolic (A) andend-diastolic (B) images are shown. Aneurysmal dilation (red arrows) and the wall motion
abnormality in the apex, anterior, and septal regions are demonstrated. Estimated left ventricularejection fraction (LVEF) is decreased to 42%.

Author's personal copy
Journal of Nuclear CardiologyÒKurebayashi et al
Viability assessment by 18F-FDG PET

Figure 3. 13N-NH3 and 18F-FDG PET. Perfusion at rest and at stress of 13N-NH3 PET/CT, and 18FFDG PET images are presented. A large-sized severe decrease located in the apex and apical to midleft ventricular wall at stress, which was partially improved at the rest, indicating combined themyocardial injury and ischemia in the left anterior descending artery territory. Significant
accumulation of 18F-FDG is confirmed even at the regions of perfusion defect, indicating preserved
myocardium viability.

Figure 4. Coronary angiography at pre- and post-PCI. Left coronary angiogram at prepercutaneous coronary intervention (PCI) showing severe stenosis in the mid left anterior
descending artery (A; red arrow) with collateral circulation. Successful reperfusion was obtained
after balloon angioplasty with drug-eluting stent (B).

Author's personal copy
Kurebayashi et al
Viability assessment by 18F-FDG PETJournal of Nuclear CardiologyÒFigure 5. Echocardiography at 6-month after PCI. End-systolic (A) and end-diastolic (B) imagesof the echocardiography are displayed. The improvement of wall motion was confirmed by theechocardiography at 6-month after percutaneous coronary intervention (PCI). LVEF was calculated
as 58%.

with functional recovery after coronary revascularization.2 This case suggested that 18F-FDG PET/CT isuseful even in patients with large LV aneurysms.
Disclosure
The authors have indicated that they have no financial
conflict of interest.

References1. Manabe O, Kikuchi T, Scholte AJHA, El Mahdiui M, Nishii R,Zhang MR, et al. Radiopharmaceutical tracers for cardiac imaging.
J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1184-0.
2. Tamaki N, Yonekura Y, Yamashita K, Saji H, Magata Y, Senda M,
et al. Positron emission tomography using fluorine-18 deoxyglucose
in evaluation of coronary artery bypass grafting. Am J Cardiol
1989;64:860-5.