Longitudinal base to apex perfusion gradients by dipyridamole positron emission tomography indicate diffuse coronary atherosclerosis

Diffuse coronary atherosclerosis is clinically important and often associated with localized stenosis but is not detected or quantified by current methods including coronary arteriography. Accordingly, I quantified the longitudinal base to apex distribution of N-13 ammonia on positron emission tomography (PET) after dipyridamole stress for 17 normal volunteers and 30 patients with abnormal coronary arteriograms. Heart images were divided into 32 short axis tomographic slices along the long axis, and each slice was divided into anterior, septal, lateral and inferior quadrant. Average relative activity for each slice in each quadrant was graphed against slice number and a third order polynomial curve was best fit to the longitudinal distribution of activity. In the patients group, average relative activity in each quadrant, except septum in mild to moderate disease group, progressively and significantly decreased from base to apex slices compared to normal group, and perfusion decreasing was more progressed in severe disease group. In 12 of the patients with one- or two-vessel disease, longitudinal base to apex perfusion gradient was observed in angiographically stenosis-free quadrant. Thus, patients with segmental coronary artery disease by arteriography have abnormal longitudinal base to apex perfusion gradients on dipyridamole PET images indicating diffuse coronary atherosclerosis. (author)