Positron emission tomo graphy imaging in the differentiatial diagnosis of cardio megaly of ischemic and noncoronarogenic origin

Objective. The study addresses differentiation of ischemic and non-ischemic cardiomegaly by positron emission tomography (PET). Design and methods. Based on echocardiography data 50 patients with cardiomegaly and reduced systolic function were included in the study: 32 patients with coronary heart disease (CHD) and 18 patients with normal coronary arteries according to angiography results (6 of them had alcohol abuse). All patients underwent PET with [13N]-ammonia and [18F]-FDG for myocardial perfusion and metabolism evaluation. A semiquantitative analysis of the images was performed. Results. All patients with CHD showed large hypoperfusion areas (more than 3 segments) matching the coronary artery flow. Perfusion/metabolism match was revealed in all (100 %) patients with CHD and perfusion/metabolism mismatch was observed in 25 (79 %) patients of the same group. The patients with noncoronarogenic cardiomegaly (NCM) had diffuse heterogeneity of myocardial perfusion, 5 of them showed small and mild perfusion defects with non-segmental distribution. The areas of abnormal perfusion were significantly larger in cases of CHD. Perfusion/metabolism match was noted in 2 (11 %) patients with NCM and none of the patients with NCM showed perfusion/metabolism mismatch. Conclusion. Diffuse heterogeneity of myocardial perfusion, non-segmental distribution of perfusion defects and lack of perfusion/metabolism mismatch are the most important features of noncoronarogenic cardiomegaly as compared to ischemic cardiomegaly.

cardiac positron emission tomography, coronary heart disease, noncoronarogenic cardiomegaly

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