⁶⁸Ga-FAPI PET/MRI in Coronary Heart Disease

Excerpt

A 60-year-old man, a month after myocardial infarction, was referred to perform ¹⁸F-FDG PET/CT scan due to a lung nodule. Electrocardiogram signified ST-elevation in II, III, aVF, V4 leads, while NT-proBNP and enzymes reportedly returned to normal. [¹⁸F] FDG PET/CT (3.7 MBq/kg) with long-fasting and low-carbohydrate food preparations revealed the diffuse uptake of the left ventricle (LV) and the extreme FDG signal in inferior and inferolateral walls (SUV_max: 12.1) (Figure 1a–c, arrow). The patient was then recruited in the clinical trial of ⁶⁸Ga-FAPI PET/MRI approved by the institutional review board of Beijing Cancer Hospital (No. 2020KT144). Cardiac MR (CMR) images unmasked less thickening and heterogenous signal in inferior and inferolateral walls of LV. Fusion images showed segmental mild FAPI uptake (SUV_max: 2.5), in excellent agreement with abnormal CMR signal and intense FDG uptake (Figure 1d–e, g, h, arrow). Cine imaging revealed LV function was impaired significantly and ejection fraction was 18% (Online Resource 1-3). Thinner infarction walls with akinesia or dyskinesia were noted and native T1 times increased to 1351 ms (reference, 1167 ± 40 ms) (Figure 1f, i, arrow).

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