1
|
Kjærulff MLG, Tolbod LP, Pryds K, Nielsen R, Madsen S, Luong TV, Gormsen LC. Clinical use of [15O]H2O/[18F]FDG viability positron emission tomography does not reliably predict left ventricular ejection fraction improvement or survival after revascularization. Eur Heart J Cardiovasc Imaging 2025; 26:969-979. [PMID: 39901814 DOI: 10.1093/ehjci/jeaf041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/17/2024] [Accepted: 01/30/2025] [Indexed: 02/05/2025] Open
Abstract
AIMS Previous observational studies suggest that preoperative imaging in patients with chronic ischaemic heart failure (iHF) may identify non-contractile, hypoperfused, yet metabolically viable (hibernating) myocardial segments that can regain function after coronary revascularization. Various imaging techniques, including positron emission tomography (PET) with retention tracers like 82Rb, have shown equivocal results. However, recent randomized studies have found limited value in these methods for predicting postoperative recovery and survival. This study, therefore, aims to assess whether PET viability imaging using the optimal perfusion tracer [15O]H2O, combined with [18F]FDG, provides better predictive accuracy. METHODS AND RESULTS Seventy-three patients with chronic iHF and reduced left ventricular ejection fraction (LVEF) (mean baseline LVEF 31 ± 9%) underwent [15O]H2O/[18F]FDG PET viability imaging before potential revascularization. The primary endpoint was a ≥5% absolute increase in LVEF from baseline to follow-up, assessed by echocardiography. In total, 31 of 73 (42%) patients were revascularized, with 16 of 31 (52%) experiencing a ≥5% LVEF improvement postoperatively. Baseline characteristics and revascularization type did not significantly differ between improvers and non-improvers. Receiver operating characteristic analysis of PET metrics to predict LVEF improvement yielded area under curve values ≤0.60, and no baseline characteristics or PET measures predicted survival in revascularized patients. CONCLUSION No [15O]H2O/[18F]FDG PET parameters predicted post-revascularization LVEF improvement or survival in patients with suspected chronic iHF. Thus, the clinical use of PET viability imaging still warrants reconsideration, particularly if non-ischaemic HF is present.
Collapse
Affiliation(s)
- Mette Louise Gram Kjærulff
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Kasper Pryds
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Simon Madsen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Thien Vinh Luong
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| |
Collapse
|
2
|
Gao D, Aykaç M, Hayden C, Beanlands RSB, deKemp RA. Rubidium-82 dose effects on myocardial blood flow measurements using a digital positron emission tomography - computed tomography scanner. J Nucl Cardiol 2025; 43:102073. [PMID: 39489373 DOI: 10.1016/j.nuclcard.2024.102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 09/17/2024] [Accepted: 10/26/2024] [Indexed: 11/05/2024]
Affiliation(s)
- David Gao
- University of Ottawa, Department of Medicine, Ottawa, ON, Canada
| | | | | | - Rob S B Beanlands
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Ottawa ON, Canada
| | - Robert A deKemp
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Ottawa ON, Canada.
| |
Collapse
|
3
|
Ruddy TD, Davies RA, Kiess MC. Development and evolution of nuclear cardiology and cardiac PET in Canada. J Med Imaging Radiat Sci 2024; 55:S3-S9. [PMID: 38637261 DOI: 10.1016/j.jmir.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Gated radionuclide angiography and myocardial perfusion imaging were developed in the United States and Europe in the 1970's and soon adopted in Canadian centers. Much of the early development of nuclear cardiology in Canada was in Toronto, Ontario and was quickly followed by new programs across the country. Clinical research in Canada contributed to the further development of nuclear cardiology and cardiac PET. The Canadian Nuclear Cardiology Society (CNCS) was formed in 1995 and became the Canadian Society of Cardiovascular Nuclear and CT Imaging (CNCT) in 2014. The CNCS had a major role in education and advocacy for cardiovascular nuclear medicine testing. The CNCS established the Dr Robert Burns Lecture and CNCT named the Canadian Society of Cardiovascular Nuclear and CT Imaging Annual Achievement Award for Dr Michael Freeman in memoriam of these two outstanding Canadian leaders in nuclear cardiology. The future of nuclear cardiology in Canada is exciting with the expanding use of SPECT imaging to include Tc-99m-pyrophosphate for diagnosis of transthyretin cardiac amyloidosis and the ongoing introduction of cardiac PET imaging.
Collapse
Affiliation(s)
- Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Ross A Davies
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marla C Kiess
- Division of Cardiology, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Bailly M, Courtehoux M, Metrard G, Angoulvant D, Ribeiro MJ. Dynamic CZT-SPECT: Characterizing the Lower Values of Myocardial Blood Flow and Reserve. Clin Nucl Med 2023; 48:969-970. [PMID: 37756437 PMCID: PMC10581433 DOI: 10.1097/rlu.0000000000004849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/14/2023] [Indexed: 09/29/2023]
Abstract
ABSTRACT CZT-SPECT myocardial perfusion enables quantification of myocardial blood flow (MBF). Normal values and thresholds have been accurately defined in PET but remain unclear in SPECT. The aim of this study was to report normal MBF and myocardial flow reserve values in very low-risk patients referred for coronary artery disease screening with dynamic SPECT, in comparison with patients experiencing coronary artery disease. Eighty-four patients (31 male) were analyzed. The mean 10 years risk of fatal cardiovascular events score was 2.7% ± 1.4%. The mean global stress MBF and myocardial flow reserve were 1.6 ± 0.6 mL/min/g and 2.7 ± 0.7.
Collapse
Affiliation(s)
- Matthieu Bailly
- From the Nuclear Medicine Department, CHR Orleans
- UPR 4301, CBM, CNRS Orleans, Orleans
| | | | - Gilles Metrard
- From the Nuclear Medicine Department, CHR Orleans
- UPR 4301, CBM, CNRS Orleans, Orleans
| | | | - Maria Joao Ribeiro
- Nuclear Medicine Department
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| |
Collapse
|
5
|
Mallet F, Poitrasson-Rivière A, Mariano-Goulart D, Agostini D, Manrique A. Measuring myocardial blood flow using dynamic myocardial perfusion SPECT: artifacts and pitfalls. J Nucl Cardiol 2023; 30:2006-2017. [PMID: 36598748 DOI: 10.1007/s12350-022-03165-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/09/2022] [Indexed: 01/05/2023]
Abstract
Dynamic acquisition allows absolute quantification of myocardial perfusion and flow reserve, offering an alternative to overcome the potential limits of relative quantification, especially in patients with balanced multivessel coronary artery disease. SPECT myocardial perfusion is widely available, at lower cost than PET. Dynamic cardiac SPECT is now feasible and has the potential to be the next step of comprehensive perfusion imaging. In order to help nuclear cardiologists potentially interested in using dynamic perfusion SPECT, we sought to review the different steps of acquisition, processing, and reporting of dynamic SPECT studies in order to enlighten the potentially critical pitfalls and artifacts. Both patient-related and technical artifacts are discussed. Key parameters of the acquisition include pharmacological stress, radiopharmaceuticals, and injection device. When it comes to image processing, attention must be paid to image-derived input function, patient motion, and extra-cardiac activity. This review also mentions compartment models, cameras, and attenuation correction. Finally, published data enlighten some facets of dynamic cardiac SPECT while several issues remain. Harmonizing acquisition and quality control procedures will likely improve its performance and clinical strength.
Collapse
Affiliation(s)
- Florian Mallet
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France
- Department of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | | | - Denis Mariano-Goulart
- Department of Nuclear Medicine, CHU of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Denis Agostini
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France.
- GIP Cyceron, Campus Jules Horowitz, Boulevard Henri Becquerel, BP 5229, 14074, Caen, France.
| |
Collapse
|
6
|
Mannarino T, Assante R, D'Antonio A, Zampella E, Cuocolo A, Acampa W. Radionuclide Tracers for Myocardial Perfusion Imaging and Blood Flow Quantification. Cardiol Clin 2023; 41:141-150. [PMID: 37003672 DOI: 10.1016/j.ccl.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Myocardial perfusion imaging by nuclear cardiology is widely validated for the diagnosis, risk stratification, and management of patients with suspected or known coronary artery disease. Numerous radiopharmaceuticals are available for single-photon emission computed tomography and PET modalities. Each tracer shows advantages and limitations that should be taken into account in performing an imaging examination. This review aimed to summarize the state-of-the-art radiotracers used for myocardial perfusion imaging and blood flow quantification, highlighting the new technologic advances and promising possible applications.
Collapse
Affiliation(s)
- Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy.
| |
Collapse
|
7
|
Cuddy-Walsh SG, deKemp RA, Ruddy TD, Wells RG. Improved precision of SPECT myocardial blood flow using a net tracer retention model. Med Phys 2022; 50:2009-2021. [PMID: 36565461 DOI: 10.1002/mp.16186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Noninvasive quantification of absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR) provides incremental benefit to relative myocardial perfusion imaging (MPI) to diagnose and manage heart disease. MBF can be measured with single-photon emission computed tomography (SPECT) but the uncertainty in the measured values is high. Standardization and optimization of protocols for SPECT MBF measurements will improve the consistency of this technique. One element of the processing protocol is the choice of kinetic model used to analyze the dynamic image series. PURPOSE This study evaluates if a net tracer retention model (RET) will provide a better fit to the acquired data and greater test-retest precision than a one-compartment model (1CM) for SPECT MBF, with (+MC) and without (-MC) manual motion correction. METHODS Data from previously acquired rest-stress MBF studies (31 SPECT-PET and 30 SPECT-SPECT) were reprocessed ± MC. Rate constants (K1) were extracted using 1CM and RET, +/-MC, and compared pairwise with standard PET MBF measurements using cross-validation to obtain calibration parameters for converting SPECT rate constants to MBF and to assess the goodness-of-fit of the calibration curves. Precision (coefficient of variation of test re-test relative differences, COV) of flow measurements was computed for 1CM and RET ± MC using data from the repeated SPECT MBF studies. RESULTS Both the RET model and MC improved the goodness-of-fit of the SPECT MBF calibration curves to PET. All models produced minimal bias compared with PET (mean bias < 0.6%). The SPECT-SPECT MBF COV significantly improved from 34% (1CM+MC) to 28% (RET+MC, P = 0.008). CONCLUSION The RET+MC model provides a better calibration of SPECT to PET and blood flow measurements with better precision than the 1CM, without loss of accuracy.
Collapse
Affiliation(s)
- Sarah G Cuddy-Walsh
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert A deKemp
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
8
|
Improving Detection of CAD and Prognosis with PET/CT Quantitative Absolute Myocardial Blood Flow Measurements. Curr Cardiol Rep 2022; 24:1855-1864. [PMID: 36348147 DOI: 10.1007/s11886-022-01805-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the role of PET MPI in the detection of CAD, focussing on the added value of MBF for diagnosis and prognostication. RECENT FINDINGS Positron emission tomography (PET) myocardial perfusion imaging (MPI) is increasingly used for the risk stratification of patients with suspected or established coronary artery disease (CAD). PET MPI provides accurate and reproducible non-invasive quantification of myocardial blood flow (MBF) at rest and during hyperemia, providing incremental information over conventional myocardial perfusion alone. Inclusion of MBF in PET MPI interpretation improves both its sensitivity and specificity. Moreover, quantitative MBF measurements have repeatedly been shown to offer incremental and independent prognostic information over conventional clinical markers in a broad range of conditions, including in CAD. Quantitative MBF measurement is now an established and powerful tool enabling accurate risk stratification and guiding patients' management. The role of PET MPI and flow quantification in cardiac allograft vasculopathy (CAV), which represents a particular form of CAD, will also be reviewed.
Collapse
|
9
|
Johnson NP, Gould KL. Retention models: 'tis the gift to be simple. J Nucl Cardiol 2022; 29:2595-2598. [PMID: 34657979 DOI: 10.1007/s12350-021-02827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA.
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
| |
Collapse
|
10
|
Poitrasson-Rivière A, Moody JB, Renaud JM, Hagio T, Arida-Moody L, Murthy VL, Ficaro EP. Effect of iterations and time of flight on normal distributions of 82Rb PET relative perfusion and myocardial blood flow. J Nucl Cardiol 2022; 29:2612-2623. [PMID: 34448094 DOI: 10.1007/s12350-021-02775-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND As clinical use of myocardial blood flow (MBF) increases, dynamic series are becoming part of the typical workflow. The methods and parameters used to reconstruct these series require investigation to ensure accurate quantification. METHODS Fifty-nine rest/stress dynamic 82Rb PET studies, acquired on a Biograph mCT, from a combination of normal volunteers and low-likelihood patients were reconstructed with and without time of flight (TOF) for varying iterations and processed to obtain relative perfusion and MBF polar maps. Regional values from mean polar maps were fit to a linear mixed-effect model to quantify convergence and select the optimal number of iterations. RESULTS TOF reconstructions converged faster and yielded more uniform relative perfusion polar maps. However, the stress MBF distribution for TOF reconstructions was more heterogeneous, with a higher-intensity septal wall. This phenomenon requires further investigation, with right ventricle blood pool spillover possibly having an effect. Optimal reconstructions were defined as 5-iteration non-TOF (24-subset) reconstructions and 3-iteration TOF (21-subset) reconstructions. CONCLUSION Optimal cardiac reconstructions were identified for non-TOF and TOF reconstructions of dynamic series. TOF reconstruction presents as the more accurate method, given the more uniform relative perfusion distribution.
Collapse
Affiliation(s)
| | - Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Drive, Suite 200, Ann Arbor, MI, 48108, USA
| | - Jennifer M Renaud
- INVIA Medical Imaging Solutions, 3025 Boardwalk Drive, Suite 200, Ann Arbor, MI, 48108, USA
| | - Tomoe Hagio
- INVIA Medical Imaging Solutions, 3025 Boardwalk Drive, Suite 200, Ann Arbor, MI, 48108, USA
| | - Liliana Arida-Moody
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Drive, Suite 200, Ann Arbor, MI, 48108, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Kamphuis ME, Kuipers H, Verschoor J, van Hespen JCG, Greuter MJW, Slart RHJA, Slump CH. Development of a dynamic myocardial perfusion phantom model for tracer kinetic measurements. EJNMMI Phys 2022; 9:31. [PMID: 35467161 PMCID: PMC9038974 DOI: 10.1186/s40658-022-00458-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Absolute myocardial perfusion imaging (MPI) is beneficial in the diagnosis and prognosis of patients with suspected or known coronary artery disease. However, validation and standardization of perfusion estimates across centers is needed to ensure safe and adequate integration into the clinical workflow. Physical myocardial perfusion models can contribute to this clinical need as these can provide ground-truth validation of perfusion estimates in a simplified, though controlled setup. This work presents the design and realization of such a myocardial perfusion phantom and highlights initial performance testing of the overall phantom setup using dynamic single photon emission computed tomography. RESULTS Due to anatomical and (patho-)physiological representation in the 3D printed myocardial perfusion phantom, we were able to acquire 22 dynamic MPI datasets in which 99mTc-labelled tracer kinetics was measured and analyzed using clinical MPI software. After phantom setup optimization, time activity curve analysis was executed for measurements with normal myocardial perfusion settings (1.5 mL/g/min) and with settings containing a regional or global perfusion deficit (0.8 mL/g/min). In these measurements, a specific amount of activated carbon was used to adsorb radiotracer in the simulated myocardial tissue. Such mimicking of myocardial tracer uptake and retention over time satisfactorily matched patient tracer kinetics. For normal perfusion levels, the absolute mean error between computed myocardial blood flow and ground-truth flow settings ranged between 0.1 and 0.4 mL/g/min. CONCLUSION The presented myocardial perfusion phantom is a first step toward ground-truth validation of multimodal, absolute MPI applications in the clinical setting. Its dedicated and 3D printed design enables tracer kinetic measurement, including time activity curve and potentially compartmental myocardial blood flow analysis.
Collapse
Affiliation(s)
- Marije E Kamphuis
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands.
| | - Henny Kuipers
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Jacqueline Verschoor
- Department of Nuclear Medicine, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | - Johannes C G van Hespen
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Marcel J W Greuter
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands.,Medical Imaging Centre, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| |
Collapse
|
12
|
Zhang X, Li H, Wu P, Yuan L, Wu Z, Liu H, Li S. The diagnosis and prognosis of coronary microvascular disease using PET/CT. Clin Hemorheol Microcirc 2021; 80:153-166. [PMID: 34958007 DOI: 10.3233/ch-201034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic and prognostic value of 13N-NH3·H2O positron emission tomography combined with computed tomography (PET/CT) for non-obstructive coronary microvascular disease (CMVD). METHODS A retrospective analysis was conducted on 70 patients with clinically suspected non-obstructive CMVD (35 males, 35 females) between March 2017 and August 2019. The average age of the patients was 53.32±7.82 years. The patients underwent 13N-NH3·H2O PET/CT and were divided into two groups based on diagnostic criteria: a CMVD group and a non-CMVD group. They were then followed up for 180-1,095 days. Data were analyzed using an χ 2 test, the logistic regression model, the multiple linear regression model, the Kaplan-Meier method, the Cox proportional hazards regression model, and a receiver operating characteristic (ROC) curve. RESULTS (1) The incidence of cardiovascular family history and a high calcification score (11-400) was higher in the CMVD group than in the non-CMVD group (58.8% vs. 20.8% and 29.4% vs. 5.7%, respectively; P < 0.05 for all), stress myocardial blood flow (MBF) and coronary flow reserve (CFR) values were lower in the CMVD group than in the non-CMVD group (2.280±0.693 vs. 3.641±1.365 and 2.142±0.339 vs. 3.700±1.123, respectively), and calcification score was higher in the CMVD group than in the non-CMVD group (110.18±165.07 vs. 13.21±41.68, respectively; P < 0.05 for all). Gender and diabetes were risk factors for stress MBF reduction (β= 1.287 and β= -0.636, respectively), calcification score and hypertension were risk factors for CFR reduction (β= -0.004 and β= -0.654, respectively), and hypertension, family history, and calcification score were risk factors in the CMVD group (OR = 7.323, OR = 5.108, OR = 1.012, respectively; P < 0.05 for all). (2) The prognosis of patients with CFR < 2.5 was worse than that of patients with CFR≥2.5 (x2 value: 27.404, P < 0.001). The risk of adverse cardiovascular events in diabetic patients was also increased (β= 0.328, P < 0.001). When CFR was set to 2.595, the prognostic sensitivity was 94% and the specificity was 80%. CONCLUSION The technology of 13N-NH3·H2O PET/CT can be used for the diagnosis and prognosis of non-obstructive CMVD. Cardiovascular risk factors are related to the occurrence and prognosis of CMVD.
Collapse
Affiliation(s)
- Xi Zhang
- Department of Nuclear Medicine, The Tumor Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Hui Li
- Department of Cardiology, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Ping Wu
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Lin Yuan
- Department of PET/CT, The Tumor Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Zhifang Wu
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Haiyan Liu
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Sijin Li
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| |
Collapse
|
13
|
Juneau D, Wu KY, Kaps N, Yao J, Renaud JM, Beanlands RSB, Ruddy TD, deKemp RA. Internal validation of myocardial flow reserve PET imaging using stress/rest myocardial activity ratios with Rb-82 and N-13-ammonia. J Nucl Cardiol 2021; 28:835-850. [PMID: 33389638 DOI: 10.1007/s12350-020-02464-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Myocardial flow reserve (MFR) measurement provides incremental diagnostic and prognostic information. The objective of the current study was to investigate the application of a simplified model for the estimation of MFR using only the stress/rest myocardial activity ratio (MAR) in patients undergoing rest-stress cardiac PET MPI. METHODS AND RESULTS Rest and dipyridamole stress dynamic PET imaging was performed in consecutive patients using 82Rb or 13NH3 (n = 250 each). Reference standard MFR was quantified using a standard one-tissue compartment model. Stress/rest myocardial activity ratio (MAR) was calculated using the LV-mean activity from 2 to 6 minutes post-injection. Simplified estimates of MFR (MFREST) were then calculated using an inverse power function. For 13NH3, there was good correlation between MFR and MFREST values (R = 0.63), with similar results for 82Rb (R = 0.73). There was no bias in the MFREST values with either tracer. The overall diagnostic performance of MFREST for detection of MFR < 2 was good with ROC area under the curve (AUC) = 83.2 ± 1.2% for 13NH3 and AUC = 90.4 ± 0.7% for 82Rb. CONCLUSION MFR was estimated with good accuracy using 82Rb and 13NH3 with a simplified method that relies only on stress/rest activity ratios. This novel approach does not require dynamic imaging or tracer kinetic modeling. It may be useful for routine quality assurance of PET MFR measurements, or in scanners where full dynamic imaging and tracer kinetic modeling is not feasible for technical or logistical reasons.
Collapse
Affiliation(s)
- Daniel Juneau
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada.
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
| | - Kai Yi Wu
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
- Department of Medicine and Dentistry (Medicine), University of Alberta, Edmonton, AB, Canada
| | - Nicole Kaps
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jason Yao
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Jennifer M Renaud
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
| | - Rob S B Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Terrence D Ruddy
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| | - Robert A deKemp
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada
| |
Collapse
|
14
|
Zavadovsky KV, Mochula AV, Boshchenko AA, Vrublevsky AV, Baev AE, Krylov AL, Gulya MO, Nesterov EA, Liga R, Gimelli A. Absolute myocardial blood flows derived by dynamic CZT scan vs invasive fractional flow reserve: Correlation and accuracy. J Nucl Cardiol 2021; 28:249-259. [PMID: 30847856 DOI: 10.1007/s12350-019-01678-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/21/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE To define the diagnostic power of absolute myocardial blood flow (MBF) evaluation on dynamic CZT imaging in intermediate risk patients in comparison with invasive coronary angiography (ICA) and fractional flow reserve (FFR). METHODS Twenty-three stable CAD patients underwent one-day dynamic rest-stress 99mTc-Sestamibi myocardial perfusion imaging by CZT camera. Stress and rest MBF values were calculated semi-automatically using a net retention model by Leppo. Coronary flow reserve (CFR) and flow difference (FD) [MBF stress - MBF rest] were also estimated. A total of 28 vessels were functionally quantified with FFR: 19 (68%) vessels with a stenosis ≥ 70% and 9 (32%) with < 70% stenotic lesions. RESULTS The mean global MBFs at rest and during stress were 0.36 (IQR 0.33-0.54) mL/min/g and 0.67 (IQR 0.55-0.81) mL/min/g, respectively, with an average CFR of 1.80 (IQR 1.35-2.24). Moderate correlations between stenosis severity and FFR (r = 0.45; P = .01), stress MBF (r = -0.46; P = .01) and FD (r = -0.37; P = .04) were detected. FFR abnormalities were best predicted by absolute stress MBF, CFR and FD with values of ≤ 0.54 mL/min/g (sensitivity 61.5%; specificity 93.3%), ≤ 1.48 (sensitivity 69.2%; specificity 93.3%) and ≤ 0.18 mL/min/g (sensitivity 69.2%; specificity 100%), respectively. CONCLUSIONS The values of stress MBF, CFR and FD obtained through dynamic CZT acquisitions compare well with invasive FFR. The clinical use of dynamic acquisition of myocardial perfusion imaging by CZT may help cardiologist in the detection of hemodynamically significant CAD.
Collapse
Affiliation(s)
- Konstantin V Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012.
| | - Andrew V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Alla A Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Alexander V Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Andrew E Baev
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Alexander L Krylov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Marina O Gulya
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | | | | | | |
Collapse
|
15
|
Gould KL, Bui L, Kitkungvan D, Patel MB. Reliability and Reproducibility of Absolute Myocardial Blood Flow: Does It Depend on the PET/CT Technology, the Vasodilator, and/or the Software? Curr Cardiol Rep 2021; 23:12. [PMID: 33483794 PMCID: PMC7822783 DOI: 10.1007/s11886-021-01449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE OF REVIEW The COURAGE and ISCHEMIA trials showed no reduced mortality after revascularization compared to medical treatment. Is this lack of benefit due to revascularization having no benefit regardless of CAD severity or to suboptimal patient selection due to non-quantitative cardiac imaging? RECENT FINDINGS Comprehensive, integrated, myocardial perfusion quantified by regional pixel distribution of coronary flow capacity (CFC) is the final common expression of objective CAD severity for which revascularization reduces mortality. Current lack of revascularization benefit derives from narrow thinking focused on measuring one isolated aspect of coronary characteristics, such as angiogram stenosis, its fractional flow reserve (FFR), anatomic FFR simulations, relative stress imaging, absolute stress ml/min/g or coronary flow reserve (CFR) alone, or even more narrowly on global CFR or fixed regions of interest in assumed coronary artery distributions, or in arbitrary 17 segments on bull's-eye displays, rather than regional pixel distribution of perfusion metrics as they actually are in an individual. Comprehensive integration of all quantitative perfusion metrics per regional pixel into coronary flow capacity guides artery-specific interventions for reduced mortality in non-acute CAD but requires addressing the methodologic questions in the title.
Collapse
Affiliation(s)
- K. Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, Houston, TX USA
| | - Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, Houston, TX USA
| | - Monica B. Patel
- Division of Cardiology, McGovern Medical School, Houston, TX USA
| |
Collapse
|
16
|
Abele JT, Raubenheimer M, Bain VG, Wandzilak G, AlHulaimi N, Coulden R, deKemp RA, Klein R, Williams RG, Warshawski RS, Lalonde LD. Quantitative blood flow evaluation of vasodilation-stress compared with dobutamine-stress in patients with end-stage liver disease using 82Rb PET/CT. J Nucl Cardiol 2020; 27:2048-2059. [PMID: 30456495 DOI: 10.1007/s12350-018-01516-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Our aim was to determine if end-stage liver disease (ESLD) is associated with an attenuated response to vasodilator-stress or dobutamine-stress using 82Rb-PET MPI with blood flow quantification. METHODS AND RESULTS Pre-liver transplant patients who had a normal dipyridamole-stress (n = 27) or dobutamine-stress (n = 26) 82Rb PET/CT MPI study with no identifiable coronary artery calcium were identified retrospectively and compared to a prospectively identified low-risk of liver disease dipyridamole-stress control group (n = 20). The dipyridamole-stress liver disease group had a lower myocardial flow reserve (MFR) (1.89 ± 0.79) than the control group (2.79 ± 0.96, P < .05). The dobutamine-stress group had a higher MFR than both other groups (3.69 ± 1.49, P < .05). A moderate negative correlation between MELD score and MFR was demonstrated for the dipyridamole-stress liver disease group (r = - 0.473, P < .05). This correlation was not observed for the dobutamine-stress liver disease group (r = - 0.253, P = .21). The liver failure group as a whole (n = 53) had a higher resting myocardial blood flow (0.97 ± 0.33 mL/min/g) than the control group (0.82 ± 0.26, P < .05). CONCLUSION Dipyridamole demonstrates an attenuated vasodilatory response in ESLD patients compared to a non-ESLD control group related to higher resting blood flow and comparatively reduced stress blood flow. Dobutamine does not demonstrate this effect implying it may be the preferred pharmacologic MPI stress agent for ESLD patients.
Collapse
Affiliation(s)
- Jonathan T Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
- Department of Radiology and Diagnostic Imaging, 2A2.42 Walter C MacKenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street NW, Edmonton, Alberta, T6G 2B7, Canada.
| | - Monique Raubenheimer
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent G Bain
- Liver Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Greg Wandzilak
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Naji AlHulaimi
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Coulden
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ran Klein
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Randall G Williams
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert S Warshawski
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Lucille D Lalonde
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
17
|
Zuo Y, Badawi RD, Foster CC, Smith T, López JE, Wang G. Multiparametric Cardiac 18F-FDG PET in Humans: Kinetic Model Selection and Identifiability Analysis. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2020; 4:759-767. [PMID: 33778234 DOI: 10.1109/trpms.2020.3031274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac 18F-FDG PET has been used in clinics to assess myocardial glucose metabolism. Its ability for imaging myocardial glucose transport, however, has rarely been exploited in clinics. Using the dynamic FDG-PET scans of ten patients with coronary artery disease, we investigate in this paper appropriate dynamic scan and kinetic modeling protocols for efficient quantification of myocardial glucose transport. Three kinetic models and the effect of scan duration were evaluated by using statistical fit quality, assessing the impact on kinetic quantification, and analyzing the practical identifiability. The results show that the kinetic model selection depends on the scan duration. The reversible two-tissue model was needed for a one-hour dynamic scan. The irreversible two-tissue model was optimal for a scan duration of around 10-15 minutes. If the scan duration was shortened to 2-3 minutes, a one-tissue model was the most appropriate. For global quantification of myocardial glucose transport, we demonstrated that an early dynamic scan with a duration of 10-15 minutes and irreversible kinetic modeling was comparable to the full one-hour scan with reversible kinetic modeling. Myocardial glucose transport quantification provides an additional physiological parameter on top of the existing assessment of glucose metabolism and has the potential to enable single tracer multiparametric imaging in the myocardium.
Collapse
Affiliation(s)
- Yang Zuo
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA 9817
| | - Ramsey D Badawi
- Department of Radiology and Department of Biomedical Engineering, University of California Davis Medical Center, Sacramento, CA 9817
| | - Cameron C Foster
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA 9817
| | - Thomas Smith
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA 9817
| | - Javier E López
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA 9817
| | - Guobao Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA 9817
| |
Collapse
|
18
|
Villemain O, Baranger J, Jalal Z, Lam C, Calais J, Pernot M, Cifra B, Friedberg MK, Mertens L. Non-invasive imaging techniques to assess myocardial perfusion. Expert Rev Med Devices 2020; 17:1133-1144. [PMID: 33044100 DOI: 10.1080/17434440.2020.1834844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Coronary artery disease affecting myocardial perfusion continues to be the leading cause of cardiovascular morbidity and mortality worldwide. While invasive evaluation based on coronary angiography and flow measurements still is considered the reference technique for assessing myocardial perfusion, technological evolutions in noninvasive imaging techniques resulted in them playing a more important role in assessing myocardial perfusion influencing therapeutic decision-making and prognostication. AREAS COVERED Different imaging modalities are used to evaluate coronary perfusion, including echocardiography, coronary computerized tomography scan, magnetic resonance imaging, and nuclear myocardial perfusion imaging. Through a combination of different techniques, it is possible to describe coronary artery anatomy and the diameter of the epicardial vessels but more recently also of the coronary microcirculation. Quantification of myocardial perfusion is feasible both at baseline and during pharmacological or physiological stress. EXPERT OPINION The objective of this state-of-the-art paper is to review the recent evolutions in imaging methods to estimate myocardial perfusion and to discuss the diagnostic strengths and limitations of the different techniques. The new ultrasound technologies and the hybrid approaches seem to be the future is these fields.
Collapse
Affiliation(s)
- Olivier Villemain
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto , Toronto, ON, Canada.,Translational Medicine Department, SickKids Research Institute , Toronto, ON, Canada.,Medical Biophysics Department, University of Toronto , Toronto, ON, Canada
| | - Jérôme Baranger
- Translational Medicine Department, SickKids Research Institute , Toronto, ON, Canada
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU) , Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université , Pessac- Bordeaux, France
| | - Christopher Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children , Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto , Toronto, ON, Canada
| | - Jérémie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, University of California Los Angeles , Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles , Los Angeles, CA, USA.,Physics & Biology in Medicine Interdepartmental Graduate Program, David Geffen School of Medicine, University of California Los Angeles , Los Angeles, CA, USA.,Institute of Urologic Oncology, University of California Los Angeles , Los Angeles, CA, USA
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University , Paris, France
| | - Barbara Cifra
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto , Toronto, ON, Canada
| | - Mark K Friedberg
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto , Toronto, ON, Canada.,Translational Medicine Department, SickKids Research Institute , Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto , Toronto, ON, Canada.,Translational Medicine Department, SickKids Research Institute , Toronto, ON, Canada
| |
Collapse
|
19
|
Harel F, Finnerty V, Authier S, Pelletier-Galarneau M. Comparison of two dipyridamole infusion protocols for myocardial perfusion imaging in subjects with low likelihood of significant obstructive coronary artery disease. J Nucl Cardiol 2020; 27:1820-1828. [PMID: 30367380 DOI: 10.1007/s12350-018-01478-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) with positron emission tomography allows accurate measurements of myocardial blood flow (MBF). Stress MBF thresholds have been proposed to provide diagnostic and prognostic information in different pathology. Most studies relying on dipyridamole use a 5-minute infusion protocol, while current guidelines recommend a 4-minute infusion. The purpose of this study is to compare the effects of different dipyridamole infusion times on stress MBF. METHODS The charts of 2,207 patients who underwent rubidium-82 MPI were retrospectively reviewed and 147 subjects with low likelihood of significant coronary artery disease (CAD) defined as calcium score = 0, body mass index < 45 kg·m-2, and summed stress score ≤ 3 were included. Of those, 65 were imaged with a 4-minute dipyridamole infusion (0.56 mg·kg-1) protocol and 82 with a 5-minute protocol (0.70 mg·kg-1). RESULTS Stress MBF (3.23±0.76 vs 3.02±0.71 mL·min-1·g-1, P = 0.09), myocardial flow reserve (2.70±0.67 vs 2.85±0.74, P = 0.20), and coronary vascular resistance index (30±10 vs 31±9 mmHg × g × min·mL-1, P = 0.38) were not significantly different between the two protocols. The 5-minute protocol was associated with higher prevalence of symptoms (92.7% vs 81.5%, P = 0.04) and greater decrease in systolic blood pressure (- 9 vs - 6 mmHg, P = 0.03). CONCLUSIONS The 4-minute and 5-minute dipyridamole infusion protocols produce comparable myocardial flow response, hemodynamic changes, and symptoms, in subjects with low likelihood of significant obstructive CAD.
Collapse
Affiliation(s)
- Francois Harel
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada
| | - Vincent Finnerty
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada
| | - Sébastien Authier
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada
| | - Matthieu Pelletier-Galarneau
- Department of Radiology and Nuclear Medicine, Montreal Heart Institute, 5000 Belanger, Montreal, QC, H1T 1C8, Canada.
| |
Collapse
|
20
|
Chang CY, Hung GU, Hsu B, Yang BH, Chang CW, Hu LH, Huang WS, Wang HE, Wu TC, Liu RS. Simplified quantification of 13N-ammonia PET myocardial blood flow: A comparative study with the standard compartment model to facilitate clinical use. J Nucl Cardiol 2020; 27:819-828. [PMID: 30324328 DOI: 10.1007/s12350-018-1450-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Short imaging protocol to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) may enhance the clinical application of 13N-ammonia cardiac PET. We assessed the flow quantitation of 13N-ammonia PET implementing simple retention model and two-compartment model. METHODS Fourteen healthy volunteers (HVT) and twenty-three clinical patients received 13N-ammonia PET/CT. The simple retention model used the first 7-minute image to quantify MBF. Global and regional MBF and MFR of the two models were compared. RESULTS Global and regional MBF and MFR of these two models were highly correlated with mildly inferior correlation in RCA territory (global R2: rest MBF = 0.79, stress MBF = 0.65, MFR = 0.77; regional R2: rest MBF ≥ 0.72, stress MBF ≥ 0.52, MFR ≥ 0.68). There were significant differences for MFR (4.04 ± 0.72, 3.66 ± 0.48, p = .02) and rest MBF (0.69 ± 0.12, 0.78 ± 0.12, p = .02) between the two models in the HVT group. CONCLUSIONS 13N-ammonia global and regional MBF and MFR from the simple retention model demonstrate strong correlations with that from the two-compartment model. Significant differences of MFR and rest MBF are noted in the HVT group, with a proposed normal reference value for the 13N-ammonia short simple retention protocol.
Collapse
Affiliation(s)
- Chih-Yung Chang
- Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Bailing Hsu
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Bang-Hung Yang
- Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Wei Chang
- Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Lien-Hsin Hu
- Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Wen-Sheng Huang
- Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Ell Wang
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Tao-Cheng Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Ren-Shyan Liu
- Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
- Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan.
- Biomedical Imaging Research Center, National Yang-Ming University, Taipei, Taiwan.
- Molecular and Genetic Imaging Core, Taiwan Animal Consortium, Taipei, Taiwan.
- Department of Nuclear Medicine, Cheng Hsin General Hospital, No. 45, Cheng Hsin St., Pai-Tou, Taipei, 112, Taiwan.
| |
Collapse
|
21
|
Moody JB, Ficaro EP, Murthy VL. Simplified quantification of PET myocardial blood flow: The need for technical standardization. J Nucl Cardiol 2020; 27:829-832. [PMID: 30397868 PMCID: PMC6500765 DOI: 10.1007/s12350-018-01497-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 40108, USA.
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 40108, USA
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
22
|
Lance Gould K, Bui L, Kitkungvan D, Pan T, Roby AE, Nguyen TT, Johnson NP. Pitfalls in quantitative myocardial PET perfusion I: Myocardial partial volume correction. J Nucl Cardiol 2020; 27:386-396. [PMID: 32095938 PMCID: PMC7174249 DOI: 10.1007/s12350-020-02073-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND PET quantitative myocardial perfusion requires correction for partial volume loss due to one-dimensional LV wall thickness smaller than scanner resolution. METHODS We aimed to assess accuracy of risk stratification for death, MI, or revascularization after PET using partial volume corrections derived from two-dimensional ACR and three-dimensional NEMA phantoms for 3987 diagnostic rest-stress perfusion PETs and 187 MACE events. NEMA, ACR, and Tree phantoms were imaged with Rb-82 or F-18 for size-dependent partial volume loss. Perfusion and Coronary Flow Capacity were recalculated using different ACR- and NEMA-derived partial volume corrections compared by Kolmogorov-Smirnov statistics to standard perfusion metrics with established correlations with MACE. RESULTS Partial volume corrections based on two-dimensional ACR rods (two equal radii) and three-dimensional NEMA spheres (three equal radii) over estimate partial volume corrections, quantitative perfusion, and Coronary Flow Capacity by 50% to 150% over perfusion metrics with one-dimensional partial volume correction, thereby substantially impairing correct risk stratification. CONCLUSIONS ACR (2-dimensional) and NEMA (3-dimensional) phantoms overestimate partial volume corrections for 1-dimensional LV wall thickness and myocardial perfusion that are corrected with a simple equation that correlates with MACE for optimal risk stratification applicable to most PET-CT scanners for quantifying myocardial perfusion.
Collapse
Affiliation(s)
- K Lance Gould
- Martin Bucksbaum Distinguished University Chair, Weatherhead P.E.T. Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX, 77030, USA.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA.
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, UT Health - Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, UT Health - Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Tinsu Pan
- Imaging Physics Department, MD Anderson Cancer, University of Texas, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Amanda E Roby
- Weatherhead PET Center, McGovern Medical School, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Tung T Nguyen
- Programming and Data Management, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Nils P Johnson
- Weatherhead Distinguished Chair of Heart Disease, Division of Cardiology, McGovern Medical School, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| |
Collapse
|
23
|
Bui L, Kitkungvan D, Roby AE, Nguyen TT, Gould KL. Pitfalls in quantitative myocardial PET perfusion II: Arterial input function. J Nucl Cardiol 2020; 27:397-409. [PMID: 32128675 PMCID: PMC7174279 DOI: 10.1007/s12350-020-02074-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 12/02/2022]
Abstract
RATIONALE We aimed to define the impact of variable arterial input function on myocardial perfusion severity that may misguide interventional decisions and relates to limited capacity of 3D PET for high-count arterial input function of standard bolus R-82. METHODS We used GE Discovery-ST 16 slice PET-CT, serial 2D and 3D acquisitions of variable Rb-82 dose in a dynamic circulating arterial function model, static resolution and uniformity phantoms, and in patients with dipyridamole stress to quantify per-pixel rest and stress cc·min-1·g-1, CFR and CFC with (+) and (-) 10% simulated change in arterial input. RESULTS For intermediate, border zone severity of stress perfusion, CFR and CFC comprising 7% of 3987 cases, simulated arterial input variability of ± 10% may cause over or underestimation of perfusion severity altering interventional decisions. In phantom tests, current 3D PET has capacity for quantifying high activity of arterial input and high-count per-pixel values of perfusion metrics per artery or branches. CONCLUSIONS Accurate, reproducible arterial input function is essential for at least 7% of patients at thresholds of perfusion severity for optimally guiding interventions and providing high-activity regional per-pixel perfusion metrics by 3D PET for displaying complex quantitative perfusion readily understood ("owned") by interventionalists to guide procedures.
Collapse
Affiliation(s)
- Linh Bui
- Department of Medicine, Division of Cardiology and Weatherhead PET Center For Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, TX USA
| | - Danai Kitkungvan
- Department of Medicine, Division of Cardiology and Weatherhead PET Center For Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, TX USA
| | - Amanda E. Roby
- Weatherhead PET Center for Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, TX USA
| | - Tung T. Nguyen
- Programming and Data Management, Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX USA
| | - K. Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
| |
Collapse
|
24
|
Bajaj NS, Hage FG, McConathy J, Bhambhvani P. Myocardial blood flow measures using cardiac positron emission tomography: Software comparisons. J Nucl Cardiol 2019; 26:2013-2017. [PMID: 30456499 DOI: 10.1007/s12350-018-01525-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Navkaranbir S Bajaj
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 777, Birmingham, AL, 35249, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Jonathan McConathy
- Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 777, Birmingham, AL, 35249, USA
| | - Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 777, Birmingham, AL, 35249, USA.
| |
Collapse
|
25
|
Byrne C, Hasbak P, Kjaer A, Thune JJ, Køber L. Impaired myocardial perfusion is associated with increasing end-systolic- and end-diastolic volumes in patients with non-ischemic systolic heart failure: a cross-sectional study using Rubidium-82 PET/CT. BMC Cardiovasc Disord 2019; 19:68. [PMID: 30902043 PMCID: PMC6431039 DOI: 10.1186/s12872-019-1047-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/15/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Myocardial flow reserve (MFR, stress/rest myocardial blood flow) is a strong marker of myocardial vasomotor function. MFR is a predictor of adverse cardiac events in patients with non-ischemic systolic heart failure and previous studies using different methods have found association between myocardial blood flow and left ventricular dilatation. The aim of this study was to investigate whether there is an association between increasing end-systolic- and end-diastolic volumes (ESV and EDV) and MFR in these patients measured with Rubidium-82 positron emission tomography computed tomography (82Rb-PET/CT) as a quantitative myocardial perfusion gold-standard. METHODS We scanned 151 patients with non-ischemic heart failure with initial left ventricular ejection fraction ≤35% with 82Rb-PET/CT at rest and adenosine-induced stress to obtain MFR and volumes. To account for differences in body surface area (BSA), we used indexed ESV (ESVI): ESV/BSA (ml/m2) and EDV (EDVI). We identified factors associated with MFR using multiple regression analyses. RESULTS Median age was 62 years (55-69 years) and 31% were women. Mean MFR was 2.38 (2.24-2.52). MFR decreased significantly with both increasing ESVI (estimate - 3.7%/10 ml/m2; 95% confidence interval [CI] -5.6 to - 1.8; P < 0.001) and increasing EDVI (estimate - 3.5%/10 ml/m2; 95% CI -5.3 to - 1.6; P < 0.001). Results remained significant after multivariable adjustment. Additionally, coronary vascular resistance during stress increased significantly with increasing ESVI (estimate: 3.1 mmHg/(ml/g/min) per (10 ml/m2); 95% CI 2.0 to 4.3; r = 0.41; P < 0.0001) and increasing EDVI (estimate: 2.7 mmHg/(ml/g/min) per (10 ml/m2); 95% CI 1.6 to 3.8; r = 0.37; P < 0.0001). CONCLUSIONS Impaired MFR assessed by 82Rb-PET/CT was significantly associated with linear increases in ESVI and EDVI in patients with non-ischemic systolic heart failure. Our findings support that impaired microvascular function may play a role in heart failure development. Clinical trials investigating MFR with regard to treatment responses may elucidate the clinical use of MFR in patients with non-ischemic systolic heart failure. TRIAL REGISTRATION Sub study of the randomized clinical trial: A DANish randomized, controlled, multicenter study to assess the efficacy of Implantable cardioverter defibrillator in patients with non-ischemic Systolic Heart failure on mortality (DANISH), ClinicalTrials.gov Identifier: NCT00541268 .
Collapse
Affiliation(s)
- Christina Byrne
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, 9441, Blegdamsvej 9, 2100-Cph, Copenhagen, Denmark. .,Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. .,Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. .,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, 9441, Blegdamsvej 9, 2100-Cph, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
26
|
Byrne C, Hasbak P, Kjær A, Thune JJ, Køber L. Myocardial perfusion during atrial fibrillation in patients with non-ischaemic systolic heart failure: a cross-sectional study using Rubidium-82 positron emission tomography/computed tomography. Eur Heart J Cardiovasc Imaging 2019; 20:233-240. [PMID: 29992262 DOI: 10.1093/ehjci/jey089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/12/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Patients with non-ischaemic systolic heart failure often have reduced myocardial blood flow without significant coronary atherosclerosis. Likewise, patients with atrial fibrillation (AF) have reduced myocardial perfusion during AF compared with sinus rhythm. The aim of this study was to explore whether there is an additive negative effect of AF during scan on the myocardial perfusion in patients with non-ischaemic systolic heart failure. Methods and results We included 27 young healthy controls and 114 patients with non-ischaemic systolic heart failure to a Rubidium-82 positron emission tomography/computed tomography perfusion scan (23 with AF during scan). To obtain the myocardial flow reserve (MFR = stress flow/rest flow), patients were scanned at rest and during adenosine-induced stress. Among patients, those with AF were older [years: 73; interquartile range (IQR) 65-78 vs. 67; IQR 60-74; P = 0.03] and more were men (87% vs. 62%; P = 0.02). Distribution of sex in controls did not differ from either patient group. Patients with AF had significantly lower MFR than patients without [MFR: 1.87; 95% confidence interval (CI) 1.58-2.22 vs. 2.50; 95% CI 2.06-2.86; percent difference: -21.5%; P = 0.01]. MFR remained significantly lower in the group with AF (estimate -24.2%; 95% CI -39.6% to -4.8%; P = 0.02) in an adjusted multivariable regression analysis. Further, patients had lower MFR compared with controls: 3.46; 95% CI 3.03-3.94; P < 0.0001. Additionally, coronary vascular resistance was highest in patients with AF and lowest in controls. Conclusion Patients with systolic heart failure had lower flow reserve than healthy controls and even lower MFR if they had AF during scan.
Collapse
Affiliation(s)
- Christina Byrne
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet 9841, Blegdansvej 9, Copenhagen, Denmark.,Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital Rigshospitalet, 4011, Blegdamsvej 9, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital Rigshospitalet, 4011, Blegdamsvej 9, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital Rigshospitalet, 4011, Blegdamsvej 9, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Jens Jakob Thune
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Bispebjerg Hospital, Ebba Lunds Vej 44, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet 9841, Blegdansvej 9, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| |
Collapse
|
27
|
Agostini D, Roule V, Nganoa C, Roth N, Baavour R, Parienti JJ, Beygui F, Manrique A. First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging 2018; 45:1079-1090. [PMID: 29497801 PMCID: PMC5953996 DOI: 10.1007/s00259-018-3958-7] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/22/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE We assessed the feasibility of myocardial blood flow (MBF) and flow reserve (MFR) estimation using dynamic SPECT with a novel CZT camera in patients with stable CAD, in comparison with 15O-water PET and fractional flow reserve (FFR). METHODS Thirty patients were prospectively included and underwent FFR measurements in the main coronary arteries (LAD, LCx, RCA). A stenosis ≥50% was considered obstructive and a FFR abnormal if ≤0.8. All patients underwent a dynamic rest/stress 99mTc-sestamibi CZT-SPECT and 15O-water PET for MBF and MFR calculation. Net retention kinetic modeling was applied to SPECT data to estimate global uptake values, and MBF was derived using Leppo correction. Ischemia by PET and CZT-SPECT was considered present if MFR was lower than 2 and 2.1, respectively. RESULTS CZT-SPECT yielded higher stress and rest MBF compared to PET for global and LAD and LCx territories, but not in RCA territory. MFR was similar in global and each vessel territory for both modalities. The sensitivity, specificity, accuracy, positive and negative predictive value of CZT-SPECT were, respectively, 83.3, 95.8, 93.3, 100 and 85.7% for the detection of ischemia and 58.3, 84.6, 81.1, 36.8 and 93% for the detection of hemodynamically significant stenosis (FFR ≤ 0.8). CONCLUSIONS Dynamic 99mTc-sestamibi CZT-SPECT was technically feasible and provided similar MFR compared to 15O-water PET and high diagnostic value for detecting impaired MFR and abnormal FFR in patients with stable CAD.
Collapse
Affiliation(s)
- Denis Agostini
- Department of Nuclear Medicine, CHU Caen, CHU Cote de Nacre, Caen, France.
- Normandy University, EA 4650, Caen, France.
| | | | - Catherine Nganoa
- Department of Nuclear Medicine, CHU Caen, CHU Cote de Nacre, Caen, France
| | | | | | | | - Farzin Beygui
- Normandy University, EA 4650, Caen, France
- Department of Cardiology, CHU Caen, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, CHU Caen, CHU Cote de Nacre, Caen, France
- Normandy University, EA 4650, Caen, France
- Cyceron PET Center, Caen, France
| |
Collapse
|
28
|
Klein R, Ocneanu A, Renaud JM, Ziadi MC, Beanlands RSB, deKemp RA. Consistent tracer administration profile improves test-retest repeatability of myocardial blood flow quantification with 82Rb dynamic PET imaging. J Nucl Cardiol 2018; 25:929-941. [PMID: 27804067 PMCID: PMC5966478 DOI: 10.1007/s12350-016-0698-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Quantification of myocardial blood flow (MBF) and stress/rest flow reserve is used increasingly to diagnose multi-vessel coronary artery disease and micro-vascular disease with PET imaging. However, variability in the measurements may limit physician confidence to direct revascularization therapies based on specific threshold values. This study evaluated the effects of rubidium-82 (82Rb) tracer injection profile using a constant-activity-rate (CA) vs a constant-flow-rate (CF) infusion to improve test-retest repeatability of MBF measurements. METHOD 22 participants underwent single-session 82Rb dynamic PET imaging during rest and dipyridamole stress using one of 2 test-retest infusion protocols: CA-CA (n = 12) or CA-CF (n = 10). MBF was quantified using a single-tissue-compartment model (1TCM) and a simplified retention model (SRM). Non-parametric test-retest repeatability coefficients (RPCnp) were compared between groups. Myocardium-to-blood contrast and signal-to-noise ratios of the late uptake images (2 to 6 minutes) were also compared to evaluate standard myocardial perfusion image (MPI) quality. RESULTS MBF values in the CA-CA group were more repeatable (smaller RPCnp) than the CA-CF group using the 1TCM at rest alone, rest and stress combined, and stress/rest reserve (21% vs 36%, 16% vs 19%, and 20% vs 27%, P < 0.05, respectively), and using the SRM at Rest and Stress alone, Rest and Stress combined, and stress/rest reserve (21% vs 38%, 15% vs 25%, 22% vs 38%, and 23% vs 49%, P < 0.05, respectively). In terms of image quality, myocardium-to-blood contrast and signal-to-noise ratios were not significantly different between groups. CONCLUSIONS Constant-activity-rate 'square-wave' infusion of 82Rb produces more repeatable tracer injection profiles and decreases the test-retest variability of MBF measurements, when compared to a constant-flow-rate 'bolus' administration of 82Rb, especially with SRM, and without compromising standard MPI quality.
Collapse
Affiliation(s)
- Ran Klein
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada.
- Division of Nuclear Medicine, Department of Medicine, The Ottawa Hospital and University of Ottawa, Box 232, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
| | - Adrian Ocneanu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada
| | - Jennifer M Renaud
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Maria C Ziadi
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Non Invasive Cardiovascular Imaging Department, Diagnostico Medico Oroño, Rosario, Argentina
| | - Rob S B Beanlands
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Division of Nuclear Medicine, Department of Medicine, The Ottawa Hospital and University of Ottawa, Box 232, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Canada
- Division of Nuclear Medicine, Department of Medicine, The Ottawa Hospital and University of Ottawa, Box 232, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| |
Collapse
|
29
|
Murthy VL, Bateman TM, Beanlands RS, Berman DS, Borges-Neto S, Chareonthaitawee P, Cerqueira MD, deKemp RA, DePuey EG, Dilsizian V, Dorbala S, Ficaro EP, Garcia EV, Gewirtz H, Heller GV, Lewin HC, Malhotra S, Mann A, Ruddy TD, Schindler TH, Schwartz RG, Slomka PJ, Soman P, Di Carli MF, Einstein A, Russell R, Corbett JR. Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Cardiol 2018; 25:269-297. [PMID: 29243073 DOI: 10.1007/s12350-017-1110-x] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | | | - Rob S Beanlands
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salvador Borges-Neto
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Duke University Health System, Durham, NC, USA
| | | | | | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - E Gordon DePuey
- Division of Nuclear Medicine, Department of Radiology, Mt. Sinai St. Luke's and Mt. Sinai West Hospitals, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward P Ficaro
- Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Henry Gewirtz
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Terrence D Ruddy
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Thomas H Schindler
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, and Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Raymond Russell
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - James R Corbett
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, and Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
30
|
PET myocardial perfusion quantification: anatomy of a spreading functional technique. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0263-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
31
|
Byrne C, Hasbak P, Kjaer A, Thune JJ, Køber L. Myocardial perfusion in patients with non-ischaemic systolic heart failure and type 2 diabetes: a cross-sectional study using Rubidium-82 PET/CT. Int J Cardiovasc Imaging 2017; 34:993-1001. [DOI: 10.1007/s10554-017-1295-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
|
32
|
Murthy VL, Bateman TM, Beanlands RS, Berman DS, Borges-Neto S, Chareonthaitawee P, Cerqueira MD, deKemp RA, DePuey EG, Dilsizian V, Dorbala S, Ficaro EP, Garcia EV, Gewirtz H, Heller GV, Lewin HC, Malhotra S, Mann A, Ruddy TD, Schindler TH, Schwartz RG, Slomka PJ, Soman P, Di Carli MF. Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Med 2017; 59:273-293. [PMID: 29242396 DOI: 10.2967/jnumed.117.201368] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Rob S Beanlands
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Salvador Borges-Neto
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Duke University Health System, Durham, North Carolina
| | | | | | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - E Gordon DePuey
- Division of Nuclear Medicine, Department of Radiology, Mt. Sinai St. Luke's and Mt. Sinai West Hospitals, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward P Ficaro
- Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Henry Gewirtz
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - April Mann
- Hartford Hospital, Hartford, Connecticut
| | - Terrence D Ruddy
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thomas H Schindler
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, and Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York; and
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | |
Collapse
|
33
|
Gould KL. Optimizing quantitative myocardial perfusion by positron emission tomography for guiding CAD management. J Nucl Cardiol 2017; 24:1950-1954. [PMID: 27638746 DOI: 10.1007/s12350-016-0666-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX, 77030, USA.
| |
Collapse
|
34
|
Klein R, Ocneanu A, deKemp RA. Time-frame sampling for 82Rb PET flow quantification: Towards standardization of clinical protocols. J Nucl Cardiol 2017; 24:1530-1534. [PMID: 28687966 DOI: 10.1007/s12350-017-0981-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Ran Klein
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Nuclear Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Adrian Ocneanu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| |
Collapse
|
35
|
Srivaratharajah K, Coutinho T, deKemp R, Liu P, Haddad H, Stadnick E, Davies RA, Chih S, Dwivedi G, Guo A, Wells GA, Bernick J, Beanlands R, Mielniczuk LM. Reduced Myocardial Flow in Heart Failure Patients With Preserved Ejection Fraction. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002562. [PMID: 27413034 DOI: 10.1161/circheartfailure.115.002562] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/12/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND There remains limited insight into the pathophysiology and therapeutic advances directed at improving prognosis for patients with heart failure with preserved ejection fraction (HFpEF). Recent studies have suggested a role for coronary microvascular dysfunction in HFpEF. Rb-82 cardiac positron emission tomography imaging is a noninvasive, quantitative approach to measuring myocardial flow reserve (MFR), a surrogate marker for coronary vascular health. The aim of this study was to determine whether abnormalities exist in MFR in patients with HFpEF without epicardial coronary artery disease. METHODS AND RESULTS A total of 376 patients with ejection fraction ≥50%, no known history of obstructive coronary artery disease, and a confirmed diagnosis of heart failure (n=78) were compared with patients with no evidence of heart failure (n=298), further stratified into those with (n=186) and without (n=112) hypertension. Global and regional left ventricular MFR was calculated as stress/rest myocardial blood flow using Rb-82 positron emission tomography. Patients with HFpEF were more likely to be older, female, and have comorbid hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, anemia, and renal dysfunction. HFpEF was associated with a significant reduction in global MFR (2.16±0.69 in HFpEF versus 2.54±0.80 in hypertensive controls; P<0.02 and 2.89±0.70 in normotensive controls; P<0.001). A diagnosis of HFpEF was associated with 2.62 times greater unadjusted odds of having low global MFR (defined as <2.0) and remained a significant predictor of reduced global MFR after adjusting for comorbidities. CONCLUSIONS HFpEF, in the absence of known history for obstructive epicardial coronary artery disease, is associated with reduced MFR independent of other risk factors.
Collapse
Affiliation(s)
| | - Thais Coutinho
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Robert deKemp
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Peter Liu
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Haissam Haddad
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Ellamae Stadnick
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Ross A Davies
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Sharon Chih
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Girish Dwivedi
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Ann Guo
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - George A Wells
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Jordan Bernick
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Robert Beanlands
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada
| | - Lisa M Mielniczuk
- From the Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada.
| |
Collapse
|
36
|
Pelletier-Galarneau M, deKemp RA, Hunter CR, Klein R, Klein M, Ironstone J, Fisher JA, Ruddy TD. Effects of Hypercapnia on Myocardial Blood Flow in Healthy Human Subjects. J Nucl Med 2017; 59:100-106. [DOI: 10.2967/jnumed.117.194308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022] Open
|
37
|
Kitkungvan D, Lai D, Zhu H, Roby AE, Johnson NP, Steptoe DD, Patel MB, Kirkeeide R, Gould KL. Optimal Adenosine Stress for Maximum Stress Perfusion, Coronary Flow Reserve, and Pixel Distribution of Coronary Flow Capacity by Kolmogorov-Smirnov Analysis. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005650. [PMID: 28213449 DOI: 10.1161/circimaging.116.005650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Different adenosine stress imaging protocols have not been systemically validated for absolute myocardial perfusion and coronary flow reserve (CFR) by positron emission tomography, where submaximal stress precludes assessing physiological severity of coronary artery disease. METHODS AND RESULTS In 127 volunteers, serial rest-stress positron emission tomography scans using rubidium-82 with various adenosine infusion protocols identified (1) the protocol with maximum stress perfusion and CFR, (2) test-retest precision in same subject, (3) stress perfusion and CFR after adenosine compared with dipyridamole, (4) heterogeneity of coronary flow capacity combining stress perfusion and CFR, and (5) potential relevance for patients with risk factors or coronary artery disease. The adenosine 6-minute infusion with rubidium-82 injection at 3 minutes caused CFR that was significantly 15.7% higher than the 4-minute adenosine infusion with rubidium-82 injection at 2 minutes and significantly more homogeneous by Kolmogorov-Smirnov analysis for histograms of 1344 pixel range of perfusion in paired positron emission tomographies. In a coronary artery disease cohort separate from volunteers of this study, compared with the 3/6-minute protocol, the 2/4-minute adenosine protocol would potentially have changed 332 of 1732 (19%) positron emission tomographies at low-risk physiological severity CFR ≥2.3 to CFR <2.0, thereby implying high-risk quantitative severity potentially appropriate for interventions but because of suboptimal stress of the 2/4 protocol in some patients. CONCLUSIONS The 6-minute adenosine infusion with rubidium-82 activation at 3 minutes produced CFR that averaged 15.7% higher than that in the 2/4-minute protocol, thereby potentially providing essential information for personalized management in some patients.
Collapse
Affiliation(s)
- Danai Kitkungvan
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Dejian Lai
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Hongjian Zhu
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Amanda E Roby
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Nils P Johnson
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Derek D Steptoe
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Monica B Patel
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Richard Kirkeeide
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - K Lance Gould
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.).
| |
Collapse
|
38
|
Germino M, Ropchan J, Mulnix T, Fontaine K, Nabulsi N, Ackah E, Feringa H, Sinusas AJ, Liu C, Carson RE. Quantification of myocardial blood flow with (82)Rb: Validation with (15)O-water using time-of-flight and point-spread-function modeling. EJNMMI Res 2016; 6:68. [PMID: 27650280 PMCID: PMC5030203 DOI: 10.1186/s13550-016-0215-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/30/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We quantified myocardial blood flow with (82)Rb PET using parameters of the generalized Renkin-Crone model estimated from (82)Rb and (15)O-water images reconstructed with time-of-flight and point spread function modeling. Previous estimates of rubidium extraction have used older-generation scanners without time-of-flight or point spread function modeling. We validated image-derived input functions with continuously collected arterial samples. METHODS Nine healthy subjects were scanned at rest and under pharmacological stress on the Siemens Biograph mCT with (82)Rb and (15)O-water PET, undergoing arterial blood sampling with each scan. Image-derived input functions were estimated from the left ventricle cavity and corrected with tracer-specific population-based scale factors determined from arterial data. Kinetic parametric images were generated from the dynamic PET images by fitting the one-tissue compartment model to each voxel's time activity curve. Mean myocardial blood flow was determined from each subject's (15)O-water k 2 images. The parameters of the generalized Renkin-Crone model were estimated from these water-based flows and mean myocardial (82)Rb K 1 estimates. RESULTS Image-derived input functions showed improved agreement with arterial measurements after a scale correction. The Renkin-Crone model fit (a = 0.77, b = 0.39) was similar to those previously published, though b was lower. CONCLUSIONS We have presented parameter estimates for the generalized Renkin-Crone model of extraction for (82)Rb PET using human (82)Rb and (15)O-water PET from high-resolution images using a state-of-the-art time-of-flight-capable scanner. These results provide a state-of-the-art methodology for myocardial blood flow measurement with (82)Rb PET.
Collapse
Affiliation(s)
- Mary Germino
- Biomedical Engineering, Yale University, New Haven, CT USA
- PET Center, Yale School of Medicine, PO Box 208048, New Haven, CT 06520-8048 USA
| | - Jim Ropchan
- PET Center, Diagnostic Radiology, School of Medicine, Yale University, New Haven, CT USA
| | - Tim Mulnix
- PET Center, Diagnostic Radiology, School of Medicine, Yale University, New Haven, CT USA
| | - Kathryn Fontaine
- PET Center, Diagnostic Radiology, School of Medicine, Yale University, New Haven, CT USA
| | - Nabeel Nabulsi
- PET Center, Diagnostic Radiology, School of Medicine, Yale University, New Haven, CT USA
| | - Eric Ackah
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT USA
| | - Herman Feringa
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT USA
| | - Albert J. Sinusas
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT USA
| | - Chi Liu
- Biomedical Engineering, Yale University, New Haven, CT USA
- PET Center, Diagnostic Radiology, School of Medicine, Yale University, New Haven, CT USA
| | - Richard E. Carson
- Biomedical Engineering, Yale University, New Haven, CT USA
- PET Center, Diagnostic Radiology, School of Medicine, Yale University, New Haven, CT USA
| |
Collapse
|
39
|
Renaud JM, Yip K, Guimond J, Trottier M, Pibarot P, Turcotte E, Maguire C, Lalonde L, Gulenchyn K, Farncombe T, Wisenberg G, Moody J, Lee B, Port SC, Turkington TG, Beanlands RS, deKemp RA. Characterization of 3-Dimensional PET Systems for Accurate Quantification of Myocardial Blood Flow. J Nucl Med 2016; 58:103-109. [PMID: 27539843 DOI: 10.2967/jnumed.116.174565] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/17/2016] [Indexed: 11/16/2022] Open
Abstract
Three-dimensional (3D) mode imaging is the current standard for PET/CT systems. Dynamic imaging for quantification of myocardial blood flow with short-lived tracers, such as 82Rb-chloride, requires accuracy to be maintained over a wide range of isotope activities and scanner counting rates. We proposed new performance standard measurements to characterize the dynamic range of PET systems for accurate quantitative imaging. METHODS 82Rb or 13N-ammonia (1,100-3,000 MBq) was injected into the heart wall insert of an anthropomorphic torso phantom. A decaying isotope scan was obtained over 5 half-lives on 9 different 3D PET/CT systems and 1 3D/2-dimensional PET-only system. Dynamic images (28 × 15 s) were reconstructed using iterative algorithms with all corrections enabled. Dynamic range was defined as the maximum activity in the myocardial wall with less than 10% bias, from which corresponding dead-time, counting rates, and/or injected activity limits were established for each scanner. Scatter correction residual bias was estimated as the maximum cavity blood-to-myocardium activity ratio. Image quality was assessed via the coefficient of variation measuring nonuniformity of the left ventricular myocardium activity distribution. RESULTS Maximum recommended injected activity/body weight, peak dead-time correction factor, counting rates, and residual scatter bias for accurate cardiac myocardial blood flow imaging were 3-14 MBq/kg, 1.5-4.0, 22-64 Mcps singles and 4-14 Mcps prompt coincidence counting rates, and 2%-10% on the investigated scanners. Nonuniformity of the myocardial activity distribution varied from 3% to 16%. CONCLUSION Accurate dynamic imaging is possible on the 10 3D PET systems if the maximum injected MBq/kg values are respected to limit peak dead-time losses during the bolus first-pass transit.
Collapse
Affiliation(s)
- Jennifer M Renaud
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa Ontario, Canada
| | - Kathy Yip
- KMH Cardiology & Diagnostic Centre, Mississauga Ontario, Canada
| | - Jean Guimond
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Mikaël Trottier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Eric Turcotte
- Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Conor Maguire
- University of Alberta Hospital, Edmonton Alberta, Canada
| | | | | | | | | | | | - Benjamin Lee
- INVIA Medical Imaging Solutions, Ann Arbor, Michigan
| | - Steven C Port
- Aurora Cardiovascular Services, Milwaukee, Wisconsin; and
| | | | - Rob S Beanlands
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa Ontario, Canada
| | - Robert A deKemp
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa Ontario, Canada
| |
Collapse
|
40
|
|
41
|
Fukushima Y, Kumita SI, Tokita Y, Sato N. Prognostic Value of Myocardial Perfusion SPECT After Intravenous Bolus Administration of Nicorandil in Patients with Acute Ischemic Heart Failure. J Nucl Med 2015; 57:385-91. [DOI: 10.2967/jnumed.115.162420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
42
|
Benefit of ECG-gated rest and stress N-13 cardiac PET imaging for quantification of LVEF in ischemic patients. Nucl Med Commun 2015. [PMID: 26225941 DOI: 10.1097/mnm.0000000000000352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND ECG-gated rest-stress cardiac PET can lead to simultaneous quantification of both left ventricular ejection fraction and flow impairment. In this study, our aim was to assess the benefit of rest and stress PET ejection fraction (EF) (EFp) in relation to single-photon emission computed tomography (SPECT) EF (EFs) and echocardiography EF (EFe). To this effect, the EFp was compared with EFs and EFe. Further, the relation between rest and stress EFp was also assessed. METHODS ECG-gated N-13 ammonia rest and stress PET imaging was performed in 26 patients. EFp values were obtained using gated reconstruction of the data in Flowquant. In 13 patients, EFs and EFe values were obtained through chart review. Correlation, analysis of variance, and Bland-Altman analyses were performed. P values less than 0.05 were used for statistical significance. RESULTS The rest and stress EFp values correlated significantly (r=0.80 and 0.71, respectively; P<0.05) with EFs values. There was moderate correlation with statistical significance (P<0.05) between the rest and stress EFp and EFe values (r=0.58 and 0.50, respectively). The mean rest and stress EFp values were not significantly different from mean EFs values. Also, the rest EFp and stress EFp values correlated well (r=0.81, P<0.05) and were not significantly different. Bland-Altman analysis showed no significant bias between the rest and stress EFp, and EFs, and EFe values. CONCLUSION Rest and stress EFp values obtained through an ECG-gated PET scan can be used for clinical diagnosis in place of conventional methods like SPECT and echocardiography.
Collapse
|
43
|
Test-retest repeatability of myocardial blood flow and infarct size using ¹¹C-acetate micro-PET imaging in mice. Eur J Nucl Med Mol Imaging 2015; 42:1589-600. [PMID: 26142729 DOI: 10.1007/s00259-015-3111-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/04/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Global and regional responses of absolute myocardial blood flow index (iMBF) are used as surrogate markers to assess response to therapies in coronary artery disease. In this study, we assessed the test-retest repeatability of iMBF imaging, and the accuracy of infarct sizing in mice using (11)C-acetate PET. METHODS (11)C-Acetate cardiac PET images were acquired in healthy controls, endothelial nitric oxide synthase (eNOS) knockout transgenic mice, and mice after myocardial infarction (MI) to estimate global and regional iMBF, and myocardial infarct size compared to (18)F-FDG PET and ex-vivo histology results. RESULTS Global test-retest iMBF values had good coefficients of repeatability (CR) in healthy mice, eNOS knockout mice and normally perfused regions in MI mice (CR = 1.6, 2.0 and 1.5 mL/min/g, respectively). Infarct size measured on (11)C-acetate iMBF images was also repeatable (CR = 17 %) and showed a good correlation with the infarct sizes found on (18)F-FDG PET and histopathology (r (2) > 0.77; p < 0.05). CONCLUSION (11)C-Acetate micro-PET assessment of iMBF and infarct size is repeatable and suitable for serial investigation of coronary artery disease progression and therapy.
Collapse
|
44
|
Bateman TM, Lance Gould K, Di Carli MF. Proceedings of the Cardiac PET Summit, 12 May 2014, Baltimore, MD : 3: Quantitation of myocardial blood flow. J Nucl Cardiol 2015; 22:571-8. [PMID: 25907353 DOI: 10.1007/s12350-015-0127-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Timothy M Bateman
- Cardiovascular Radiologic Imaging, The Mid America Heart and Vascular Institute, Saint Luke's Health System, Kansas City, MO, USA,
| | | | | |
Collapse
|
45
|
Johnson NP, Gould KL. Regadenoson versus dipyridamole hyperemia for cardiac PET imaging. JACC Cardiovasc Imaging 2015; 8:438-447. [PMID: 25797122 DOI: 10.1016/j.jcmg.2014.11.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The goal of this study was to compare regadenoson and dipyridamole hyperemia for quantitative myocardial perfusion imaging. BACKGROUND Regadenoson is commonly used for stress perfusion imaging. However, no study in nuclear cardiology has employed a paired design to compare quantitative hyperemic flow from regadenoson to more traditional agents such as dipyridamole. Additionally, the timing of regadenoson bolus relative to tracer administration can be expected to affect quantitative flow. METHODS Subjects underwent 2 rest/stress cardiac positron emission tomography scans using an Rb-82 generator. Each scan employed dipyridamole and a second drug in random sequence, either regadenoson according to 5 timing sequences or repeated dipyridamole. A validated retention model quantified absolute flow and coronary flow reserve. RESULTS A total of 176 pairs compared regadenoson (126 pairs, split unevenly among 5 timing sequences) or repeated dipyridamole (50 pairs). The cohort largely had few symptoms, only risk factors, and nearly normal relative uptake images, with 8% typical angina or dyspnea, 20% manifest coronary artery disease, and a minimum quadrant average of 80% (interquartile range: 76% to 83%) on dipyridamole scans. Hyperemic flow varied among regadenoson timing sequences but showed consistently lower stress flow and coronary flow reserve compared with dipyridamole. A timing sequence most similar to the regadenoson package insert achieved about 80% of dipyridamole hyperemia, whereas further delaying radiotracer injection reached approximately 90% of dipyridamole hyperemia. Because of the small numbers of pairs for each regadenoson timing protocol and a paucity of moderate or large perfusion defects, we did not observe a difference in relative uptake. CONCLUSIONS With the standard timing protocol from the package insert, regadenoson achieved only 80% of dipyridamole hyperemia quantitatively imaged by cardiac positron emission tomography using Rb-82. A nonstandard protocol using a more delayed radionuclide injection after the regadenoson bolus improved its effect to 90% of dipyridamole hyperemia.
Collapse
Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas.
| | - K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas
| |
Collapse
|
46
|
Bateman TM, Case JA. Variability in normal myocardial blood flow measurements: physiologic, methodologic, or protocol related? J Nucl Cardiol 2015; 22:85-8. [PMID: 25342214 DOI: 10.1007/s12350-014-0007-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Timothy M Bateman
- Saint-Lukes Cardiovascular Consultants Mid America Heart Institute, Kansas City, MO, USA,
| | | |
Collapse
|
47
|
Klein R, Hung GU, Wu TC, Huang WS, Li D, deKemp RA, Hsu B. Feasibility and operator variability of myocardial blood flow and reserve measurements with ⁹⁹mTc-sestamibi quantitative dynamic SPECT/CT imaging. J Nucl Cardiol 2014; 21:1075-88. [PMID: 25280761 DOI: 10.1007/s12350-014-9971-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 07/14/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Myocardial blood flow (MBF) quantification with dynamic SPECT could lead to widespread utilization of MBF imaging in clinical practice with little cost increase over current standard SPECT myocardial perfusion imaging. This work evaluates the feasibility and operator-dependent variability of MBF and flow reserve measurements with (99m)Tc-sestamibi (MIBI) dynamic SPECT imaging using a standard dual-head SPECT camera. METHODS Twenty-eight patients underwent dipyridamole-stress and rest imaging with dynamic SPECT/CT acquisition. Quantitative images were iteratively reconstructed with all physical corrections and then myocardial and arterial blood regions of interest (ROI) were defined semi-automatically. A compartmental model was fitted to these ROI-sampled time-activity-curves, and flow-dependent MIBI extraction correction was applied to derive regional MBF values. Myocardial flow reserve (MFR) was estimated as stress/rest MBF ratio. MBF and MFR in low and high risk populations were evaluated for ability to detect disease. Images were each processed twice (≥7 days apart) by one expert and one novice operator to evaluate intra- and inter-operator variability of MBF and MFR measurement in the three coronary artery vascular territories. RESULTS Mean rest flow, stress flow, and MFR values were 0.83, 1.82 mL·minute(-1)·g(-1), and 2.45, respectively. For stress/rest MFR, the inter-operator reproducibility was r(2) = 0.86 with RPC = 1.1. Stress MBF and MFR were significantly reduced (P < .05) in high risk (n = 9) vs low risk populations (n = 19), indicating ability to detect disease. For expert and novice operators very good intra-operator correlations of r(2) = 0.98 and 0.95 (n = 168, P < .001) were observed for combined rest and stress regional flow values. Bland-Altman reproducibility coefficients (RPC) were 0.25 and 0.47 mL·minute(-1)·g(-1) for the expert and novice operators, respectively (P < .001). Inter-operator correlation was r(2) = 0.91 and Bland-Altman RPC = 0.58 mL·minute(-1)·g(-1) (n = 336). CONCLUSIONS MBF and reserve measurements using (99m)Tc-sestamibi on a traditional, two-headed camera with fast rotation and with quantitative dynamic SPECT appears to be feasible, warranting further investigation.
Collapse
Affiliation(s)
- Ran Klein
- University of Ottawa Heart Institute, Cardiac PET Centre, 40 Ruskin St., Ottawa, ON, K1Y 4W7, Canada,
| | | | | | | | | | | | | |
Collapse
|
48
|
Camici PG, d'Amati G, Rimoldi O. Coronary microvascular dysfunction: mechanisms and functional assessment. Nat Rev Cardiol 2014; 12:48-62. [DOI: 10.1038/nrcardio.2014.160] [Citation(s) in RCA: 355] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
49
|
Peelukhana SV, Kerr H, Kolli KK, Fernandez-Ulloa M, Gerson M, Effat M, Arif I, Helmy T, Banerjee R. Benefit of cardiac N-13 PET CFR for combined anatomical and functional diagnosis of ischemic coronary artery disease: a pilot study. Ann Nucl Med 2014; 28:746-60. [DOI: 10.1007/s12149-014-0869-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/05/2014] [Indexed: 01/26/2023]
|
50
|
Hsu B. PET tracers and techniques for measuring myocardial blood flow in patients with coronary artery disease. J Biomed Res 2013; 27:452-9. [PMID: 24285943 PMCID: PMC3841470 DOI: 10.7555/jbr.27.20130136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/18/2013] [Indexed: 01/05/2023] Open
Abstract
Assessment of the relative distribution of myocardial flow with myocardial perfusion imaging (MPI) is methodologically limited to predict the presence or absence of flow-limited coronary artery disease (CAD). This limitation may often occur, when obstructive lesions involve multiple epicardial coronary arteries or disease-related disturbances of the coronary circulation coexist at the microvascular level. Non-invasive assessment of myocardial blood flow in absolute units with position emission tomography (PET) has been positioned as the solution to improve CAD diagnosis and prediction of patient outcomes associated with risks for cardiac events. This article reviews technical and clinical aspects of myocardial blood flow quantitation with PET and discusses the practical consideration of this approach toward worldwide clinical utilization.
Collapse
Affiliation(s)
- Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MS 65211, USA
| |
Collapse
|