Detection and characterization of thrombosis in humans using fibrin-targeted positron emission tomography and magnetic resonance Articles uri icon

authors

  • IZQUIERDO GARCÍA, DAVID
  • DÉSOGÈRE, PAULINE
  • PHILIP, ANNE L.
  • MEKKAOUI, CHOUKRI
  • WEINER, RORY B.
  • CATALANO, ONOFRIO A.
  • CHEN, YIN-CHING IRIS
  • YEH, DOREEN DEFARIA
  • MANSOUR, MOUSSA
  • CATANA, CIPRIAN
  • CARAVAN, PETER
  • SOSNOVIK, DAVID E.

publication date

  • March 2022

start page

  • 504

end page

  • 515

issue

  • 3

volume

  • 15

International Standard Serial Number (ISSN)

  • 1936-878X

Electronic International Standard Serial Number (EISSN)

  • 1876-7591

abstract

  • Objectives: The authors present a novel technique to detect and characterize LAA thrombus in humans using combined positron emission tomography (PET)/cardiac magnetic resonance (CMR) of a fibrin-binding radiotracer, [64Cu]FBP8.
    Background: The detection of thrombus in the left atrial appendage (LAA) is vital in the prevention of stroke and is currently performed using transesophageal echocardiography (TEE).
    Methods: The metabolism and pharmacokinetics of [64Cu]FBP8 were studied in 8 healthy volunteers. Patients with atrial fibrillation and recent TEEs of the LAA (positive n = 12, negative n = 12) were injected with [64Cu]FBP8 and imaged with PET/CMR, including mapping the longitudinal magnetic relaxation time (T1) in the LAA.
    Results: [64Cu]FBP8 was stable to metabolism and was rapidly eliminated. The maximum standardized uptake value (SUVMax) in the LAA was significantly higher in the TEE-positive than TEE-negative subjects (median of 4.0 [interquartile range (IQR): 3.0-6.0] vs 2.3 [IQR: 2.1-2.5]; P < 0.001), with an area under the receiver-operating characteristic curve of 0.97. An SUVMax threshold of 2.6 provided a sensitivity of 100% and specificity of 84%. The minimum T1 (T1Min) in the LAA was 970 ms (IQR: 780-1,080 ms) vs 1,380 ms (IQR: 1,120-1,620 ms) (TEE positive vs TEE negative; P < 0.05), with some overlap between the groups. Logistic regression using SUVMax and T1Min allowed all TEE-positive and TEE-negative subjects to be classified with 100% accuracy.
    Conclusions: PET/CMR of [64Cu]FBP8 is able to detect acute as well as older platelet-poor thrombi with excellent accuracy. Furthermore, the integrated PET/CMR approach provides useful information on the biological properties of thrombus such as fibrin and methemoglobin content. (Imaging of LAA Thrombosis; NCT03830320)

subjects

  • Biology and Biomedicine

keywords

  • atrial fibrillation; fibrin; left atrial appendage; mri; pet; thrombus