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Guo X, Shi L, Chen X, Liu Q, Zhou B, Xie H, Liu YH, Palyo R, Miller EJ, Sinusas AJ, Staib L, Spottiswoode B, Liu C, Dvornek NC. TAI-GAN: A Temporally and Anatomically Informed Generative Adversarial Network for early-to-late frame conversion in dynamic cardiac PET inter-frame motion correction. Med Image Anal 2024; 96:103190. [PMID: 38820677 PMCID: PMC11180595 DOI: 10.1016/j.media.2024.103190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/12/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
Inter-frame motion in dynamic cardiac positron emission tomography (PET) using rubidium-82 (82Rb) myocardial perfusion imaging impacts myocardial blood flow (MBF) quantification and the diagnosis accuracy of coronary artery diseases. However, the high cross-frame distribution variation due to rapid tracer kinetics poses a considerable challenge for inter-frame motion correction, especially for early frames where intensity-based image registration techniques often fail. To address this issue, we propose a novel method called Temporally and Anatomically Informed Generative Adversarial Network (TAI-GAN) that utilizes an all-to-one mapping to convert early frames into those with tracer distribution similar to the last reference frame. The TAI-GAN consists of a feature-wise linear modulation layer that encodes channel-wise parameters generated from temporal information and rough cardiac segmentation masks with local shifts that serve as anatomical information. Our proposed method was evaluated on a clinical 82Rb PET dataset, and the results show that our TAI-GAN can produce converted early frames with high image quality, comparable to the real reference frames. After TAI-GAN conversion, the motion estimation accuracy and subsequent myocardial blood flow (MBF) quantification with both conventional and deep learning-based motion correction methods were improved compared to using the original frames. The code is available at https://github.com/gxq1998/TAI-GAN.
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Affiliation(s)
- Xueqi Guo
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
| | | | - Xiongchao Chen
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Qiong Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Bo Zhou
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Huidong Xie
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Yi-Hwa Liu
- Department of Internal Medicine, Yale University, New Haven, CT, USA
| | | | - Edward J Miller
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Internal Medicine, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Internal Medicine, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Lawrence Staib
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | | | - Chi Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Nicha C Dvornek
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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Callegari S, Feher A, Smolderen KG, Mena-Hurtado C, Sinusas AJ. Multi-modality imaging for assessment of the microcirculation in peripheral artery disease: Bench to clinical practice. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 42:100400. [PMID: 38779485 PMCID: PMC11108852 DOI: 10.1016/j.ahjo.2024.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Peripheral artery disease (PAD) is a highly prevalent disorder with a high risk of mortality and amputation despite the introduction of novel medical and procedural treatments. Microvascular disease (MVD) is common among patients with PAD, and despite the established role as a predictor of amputations and mortality, MVD is not routinely assessed as part of current standard practice. Recent pre-clinical and clinical perfusion and molecular imaging studies have confirmed the important role of MVD in the pathogenesis and outcomes of PAD. The recent advancements in the imaging of the peripheral microcirculation could lead to a better understanding of the pathophysiology of PAD, and result in improved risk stratification, and our evaluation of response to therapies. In this review, we will discuss the current understanding of the anatomy and physiology of peripheral microcirculation, and the role of imaging for assessment of perfusion in PAD, and the latest advancements in molecular imaging. By highlighting the latest advancements in multi-modality imaging of the peripheral microcirculation, we aim to underscore the most promising imaging approaches and highlight potential research opportunities, with the goal of translating these approaches for improved and personalized management of PAD in the future.
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Affiliation(s)
- Santiago Callegari
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Kim G. Smolderen
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Vascular Medicine Outcomes Program, Yale University, New Haven, CT, USA
| | - Albert J. Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
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3
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Bors S, Abler D, Dietz M, Andrearczyk V, Fageot J, Nicod-Lalonde M, Schaefer N, DeKemp R, Kamani CH, Prior JO, Depeursinge A. Comparing various AI approaches to traditional quantitative assessment of the myocardial perfusion in [ 82Rb] PET for MACE prediction. Sci Rep 2024; 14:9644. [PMID: 38671059 PMCID: PMC11053111 DOI: 10.1038/s41598-024-60095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Assessing the individual risk of Major Adverse Cardiac Events (MACE) is of major importance as cardiovascular diseases remain the leading cause of death worldwide. Quantitative Myocardial Perfusion Imaging (MPI) parameters such as stress Myocardial Blood Flow (sMBF) or Myocardial Flow Reserve (MFR) constitutes the gold standard for prognosis assessment. We propose a systematic investigation of the value of Artificial Intelligence (AI) to leverage [82 Rb] Silicon PhotoMultiplier (SiPM) PET MPI for MACE prediction. We establish a general pipeline for AI model validation to assess and compare the performance of global (i.e. average of the entire MPI signal), regional (17 segments), radiomics and Convolutional Neural Network (CNN) models leveraging various MPI signals on a dataset of 234 patients. Results showed that all regional AI models significantly outperformed the global model ( p < 0.001 ), where the best AUC of 73.9% (CI 72.5-75.3) was obtained with a CNN model. A regional AI model based on MBF averages from 17 segments fed to a Logistic Regression (LR) constituted an excellent trade-off between model simplicity and performance, achieving an AUC of 73.4% (CI 72.3-74.7). A radiomics model based on intensity features revealed that the global average was the least important feature when compared to other aggregations of the MPI signal over the myocardium. We conclude that AI models can allow better personalized prognosis assessment for MACE.
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Affiliation(s)
- Sacha Bors
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Informatics, School of Management, HES-SO Valais-Wallis University of Applied Sciences and Arts Western Switzerland, Sierre, Switzerland
| | - Daniel Abler
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Informatics, School of Management, HES-SO Valais-Wallis University of Applied Sciences and Arts Western Switzerland, Sierre, Switzerland
| | - Matthieu Dietz
- INSERM U1060, CarMeN laboratory, University of Lyon, Lyon, France
| | - Vincent Andrearczyk
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Informatics, School of Management, HES-SO Valais-Wallis University of Applied Sciences and Arts Western Switzerland, Sierre, Switzerland
| | - Julien Fageot
- AudioVisual Communications Laboratory (LCAV), EPFL, Lausanne, Switzerland
| | - Marie Nicod-Lalonde
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | - Robert DeKemp
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Christel H Kamani
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland.
- University of Lausanne, Lausanne, Switzerland.
| | - Adrien Depeursinge
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Informatics, School of Management, HES-SO Valais-Wallis University of Applied Sciences and Arts Western Switzerland, Sierre, Switzerland
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Hoff CM, Sørensen J, Kero T, Bouchelouche K, Harms HJ, Frøkiær J, Gormsen LC, Tolbod LP. Quantitative and qualitative comparison of Rubidium-82 and Oxygen-15 water cardiac PET. J Nucl Cardiol 2024; 32:101796. [PMID: 38278706 DOI: 10.1016/j.nuclcard.2024.101796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Differences in tracer characteristics may influence the interpretation of positron emission tomography myocardial perfusion imaging (MPI). We compare the reading of MPIs with a low-extraction retention tracer (82Rb) and a high-extraction non-retention tracer (15O-water) in a selected cohort of patients with known coronary artery disease (CAD). METHODS Thirty-nine patients with known CAD referred to 82Rb MPI due to angina underwent rest and stress imaging with both tracers and experienced MPI readers provided blinded consensus reads of all studies. In addition, a comparison of regional and global quantitative measures of perfusion was performed. RESULTS The results showed 74 % agreement in the reading of 82Rb and 15O-water MPI for regional reversible ischemia and global disease, and 82 % agreement for regional irreversible ischemia. The 15O-water MPI identified more cases of global disease (n = 12 (15O-water) vs n = 4 (82Rb), p = 0.03), whereas differences in reversible ischemia (n = 22 vs n = 16, p = 0.11) and, irreversible ischemia (n = 8 vs n = 11, p = 0.45) were not significant. The correlation between myocardial blood flow measured using the two tracers was similar to previous studies (R2 = 0.78) with wide limits of agreement (-0.93 to 0.84 ml/g/min). CONCLUSIONS Agreement between consensus readings of 82Rb and 15O-water MPI was good in patients with known CAD. In this limited size study, no significant differences in the identification of reversible and irreversible ischemia found, whereas 15O-water MPI had a higher positive rate for suspected global disease.
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Affiliation(s)
- Camilla Molich Hoff
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Kero
- Nuclear Medicine & PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars C Gormsen
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars P Tolbod
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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5
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Krakauer M, Ismail A, Talleruphuus U, Henriksen AC, Lonsdale MN, Rasmussen IL, Fuglsang S, Prescott E, Hovind P, Marner L. 82Rb and [ 15O]H 2O myocardial perfusion PET imaging: a prospective head to head comparison. J Nucl Cardiol 2023; 30:2790-2802. [PMID: 37789106 PMCID: PMC10682292 DOI: 10.1007/s12350-023-03372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/15/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND 82Rb PET and [15O]H2O PET are both validated tracers for myocardical perfusion imaging but have not previously been compared clinically. During our site's transition from 82Rb to [15O]H2O PET, we performed a head-to-head comparison in a mixed population with suspected ischemic heart disease. METHODS A total of 37 patients referred for perfusion imaging due to suspicion of coronary stenosis were examined with both 82Rb and [15O]H2O PET on the same day in rest and during adenosine-induced stress. The exams were rated by two blinded readers as normal, regional ischemia, globally reduced myocardial perfusion, or myocardial scarring. For [15O]H2O PET, regional ischemia was defined as two neighboring segments with average stress perfusion ≤ 2.3 mL/(min·g). Further, we evaluated a total perfusion deficit (TPD) of ≥ 10% as a more conservative marker of ischemia. RESULTS [15O]H2O PET identified more patients with regional ischemia: 17(46%) vs 9(24%), agreement: 59% corresponding to a Cohen's kappa of .31 [95%CI .08-.53], (P < .001). Using the more conservative TPD ≥ 10%, the agreement increased to 86% corresponding to a kappa of .62 [95%CI .33-.92], (P = .001). For the subgroup of patients with no known heart disease (n = 18), the agreement was 94%. Interrater agreement was 95% corresponding to a kappa of .89 [95%CI .74-1.00] (P < .001). CONCLUSIONS In clinical transition from 82Rb to [15O]H2O PET, it is important to take into account the higher frequency of patients with regional ischemia detected by [15O]H2O PET.
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Affiliation(s)
- Martin Krakauer
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Afefah Ismail
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ulrik Talleruphuus
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Alexander Cuculiza Henriksen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Markus N Lonsdale
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Inge Lise Rasmussen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stefan Fuglsang
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Hovind
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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6
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Guo X, Shi L, Chen X, Zhou B, Liu Q, Xie H, Liu YH, Palyo R, Miller EJ, Sinusas AJ, Spottiswoode B, Liu C, Dvornek NC. TAI-GAN: Temporally and Anatomically Informed GAN for Early-to-Late Frame Conversion in Dynamic Cardiac PET Motion Correction. SIMULATION AND SYNTHESIS IN MEDICAL IMAGING : ... INTERNATIONAL WORKSHOP, SASHIMI ..., HELD IN CONJUNCTION WITH MICCAI ..., PROCEEDINGS. SASHIMI (WORKSHOP) 2023; 14288:64-74. [PMID: 38464964 PMCID: PMC10923183 DOI: 10.1007/978-3-031-44689-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The rapid tracer kinetics of rubidium-82 (82Rb) and high variation of cross-frame distribution in dynamic cardiac positron emission tomography (PET) raise significant challenges for inter-frame motion correction, particularly for the early frames where conventional intensity-based image registration techniques are not applicable. Alternatively, a promising approach utilizes generative methods to handle the tracer distribution changes to assist existing registration methods. To improve frame-wise registration and parametric quantification, we propose a Temporally and Anatomically Informed Generative Adversarial Network (TAI-GAN) to transform the early frames into the late reference frame using an all-to-one mapping. Specifically, a feature-wise linear modulation layer encodes channel-wise parameters generated from temporal tracer kinetics information, and rough cardiac segmentations with local shifts serve as the anatomical information. We validated our proposed method on a clinical 82Rb PET dataset and found that our TAI-GAN can produce converted early frames with high image quality, comparable to the real reference frames. After TAI-GAN conversion, motion estimation accuracy and clinical myocardial blood flow (MBF) quantification were improved compared to using the original frames. Our code is published at https://github.com/gxq1998/TAI-GAN.
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Affiliation(s)
- Xueqi Guo
- Yale University, New Haven, CT 06511, USA
| | - Luyao Shi
- IBM Research, San Jose, CA 95120, USA
| | | | - Bo Zhou
- Yale University, New Haven, CT 06511, USA
| | - Qiong Liu
- Yale University, New Haven, CT 06511, USA
| | | | - Yi-Hwa Liu
- Yale University, New Haven, CT 06511, USA
| | | | | | | | | | - Chi Liu
- Yale University, New Haven, CT 06511, USA
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Højstrup S, Hansen KW, Talleruphuus U, Marner L, Bjerking L, Jakobsen L, Christiansen EH, Bouchelouche K, Wiinberg N, Guldbrandsen K, Galatius S, Prescott E. Myocardial Flow Reserve, an Independent Prognostic Marker of All-Cause Mortality Assessed by 82Rb PET Myocardial Perfusion Imaging: A Danish Multicenter Study. Circ Cardiovasc Imaging 2023; 16:e015184. [PMID: 37529907 DOI: 10.1161/circimaging.122.015184] [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: 12/21/2022] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Rubidium-82 positron emission tomography (82Rb PET) myocardial perfusion imaging is used in clinical practice to quantify regional perfusion defects. Additionally, 82Rb PET provides a measure of absolute myocardial flow reserve (MFR), describing the vasculature state of health. We assessed whether 82Rb PET-derived MFR is associated with all-cause mortality independently of the extent of perfusion defects. METHODS We conducted a multicenter clinical registry-based study of patients undergoing 82Rb PET myocardial perfusion imaging on suspicion of chronic coronary syndromes. Patients were followed up in national registries for the primary outcome of all-cause mortality. Global MFR ≤2 was considered reduced. RESULTS Among 7169 patients studied, 38.1% were women, the median age was 69 (IQR, 61-76) years, and 39.0% had MFR ≤2. A total of 667 (9.3%) patients died during a median follow-up of 3.1 (IQR, 2.6-4.0) years, more in patients with MFR ≤2 versus MFR >2 (15.7% versus 5.2%; P<0.001). MFR ≤2 was associated with all-cause mortality across subgroups defined by the extent of perfusion defects (all P<0.05). In a Cox survival regression model adjusting for sex, age, comorbidities, kidney function, left ventricular ejection fraction, and perfusion defects, MFR ≤2 was a robust predictor of mortality with a hazard ratio of 1.62 (95% CI, 1.31-2.02; P<0.001). Among patients with no reversible perfusion defects (n=3101), MFR ≤2 remained strongly associated with mortality (hazard ratio, 1.86 [95% CI, 1.26-2.73]; P<0.01). The prognostic value of impaired MFR was similar for cardiac and noncardiac death. CONCLUSIONS MFR ≤2 predicts all-cause mortality independently of the extent of perfusion defects. Our results support the inclusion of MFR when assessing the prognosis of patients suspected of chronic coronary syndromes.
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Affiliation(s)
- Signe Højstrup
- Department of Cardiology (S.H., K.W.H., L.B., S.G., E.P.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Kim W Hansen
- Department of Cardiology (S.H., K.W.H., L.B., S.G., E.P.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Ulrik Talleruphuus
- Department of Clinical Physiology and Nuclear Medicine (U.T., L.M., N.W., K.G.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine (U.T., L.M., N.W., K.G.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Louise Bjerking
- Department of Cardiology (S.H., K.W.H., L.B., S.G., E.P.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Lars Jakobsen
- Department of Cardiology (L.J., E.H.C.), Aarhus University Hospital, Denmark
| | | | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET Center (K.B.), Aarhus University Hospital, Denmark
| | - Niels Wiinberg
- Department of Clinical Physiology and Nuclear Medicine (U.T., L.M., N.W., K.G.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Kasper Guldbrandsen
- Department of Clinical Physiology and Nuclear Medicine (U.T., L.M., N.W., K.G.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark (K.G.)
| | - Søren Galatius
- Department of Cardiology (S.H., K.W.H., L.B., S.G., E.P.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Eva Prescott
- Department of Cardiology (S.H., K.W.H., L.B., S.G., E.P.), Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
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8
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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.
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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.
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9
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Rauf M, Hansen KW, Galatius S, Wiinberg N, Brinth LS, Højstrup S, Talleruphuus U, Prescott E. Prognostic implications of myocardial perfusion imaging by 82-rubidium positron emission tomography in male and female patients with angina and no perfusion defects. Eur Heart J Cardiovasc Imaging 2023; 24:212-222. [PMID: 36394344 DOI: 10.1093/ehjci/jeac217] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022] Open
Abstract
AIMS Myocardial perfusion imaging with 82-rubidium positron emission tomography (82Rb-PET) is increasingly used to assess stable coronary artery disease (CAD). We aimed to evaluate the prognostic value of 82Rb-PET-derived parameters in patients with symptoms suggestive of CAD but no significant reversible or irreversible perfusion defects. METHODS AND RESULTS Among 3726 consecutive patients suspected of stable CAD who underwent 82Rb-PET between January 2018 and August 2020, 2175 had no regional perfusion defects. Among these patients, we studied the association of 82Rb-PET-derived parameters with a composite endpoint of all-cause mortality, hospitalization for unstable angina pectoris, acute myocardial infarction, heart failure, or ischaemic stroke. During a median follow up of 1.7 years (interquartile range 1.1-2.5 years), there were 148 endpoints. Myocardial blood flow (MBF) reserve (MFR), MBF during stress, left ventricular ejection fraction (LVEF), LVEF-reserve, heart rate reserve, and Ca score were associated with adverse outcomes. In multivariable Cox model adjusted for patient and 82Rb-PET characteristics, MFR < 2 (hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.24-2.48), LVEF (HR 1.38 per 10% decrease, 95% CI 1.24-1.54), and LVEF-reserve (HR 1.19 per 5% decrease, 95% CI 1.07-1.31) were significant predictors of endpoints. Results were consistent in subgroups defined by gender, history of ischaemic heart disease, low LVEF, and atrial fibrillation. CONCLUSION MFR, LVEF, and LVEF-reserve derived from 82Rb-PET provide prognostic information on cardiovascular outcomes in patients with no perfusion defects. This may aid in identifying patients at risk and might provide an opportunity for preventive interventions.
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Affiliation(s)
- Maira Rauf
- Department of Cardiology, Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Kim W Hansen
- Department of Cardiology, Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Niels Wiinberg
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Louise Scouborg Brinth
- Department of Imaging and Radiology, Copenhagen University Hospital-North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Signe Højstrup
- Department of Cardiology, Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Ulrik Talleruphuus
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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10
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Han Y, Ahmed AI, Hayden C, Jung AK, Saad JM, Spottiswoode B, Nabi F, Al-Mallah MH. Change in positron emission tomography perfusion imaging quality with a data-driven motion correction algorithm. J Nucl Cardiol 2022; 29:3426-3431. [PMID: 35275348 DOI: 10.1007/s12350-021-02902-5] [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: 09/12/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Cardiac motion frequently reduces the interpretability of PET images. This study utilized a prototype data-driven motion correction (DDMC) algorithm to generate corrected images and compare DDMC images with non-corrected images (NMC) to evaluate image quality and change of perfusion defect size and severity. METHODS Rest and stress images with NMC and DDMC from 40 consecutive patients with motion were rated by 2 blinded investigators on a 4-point visual ordinal scale (0: minimal motion; 1: mild motion; 2: moderate motion; 3: severe motion/uninterpretable). Motion was also quantified using Dwell Fraction, which is the fraction of time the motion vector shows the heart to be within 6 mm of the corrected position and was derived from listmode data of NMC images. RESULTS Minimal motion was seen in 15% of patients, while 40%, 30%, and 15% of patients had mild moderate and severe motion, respectively. All corrected images showed an improvement in quality and were interpretable after processing. This was confirmed by a significant correlation (Spearman's correlation coefficient 0.626, P < .001) between machine measurement of motion quantification and physician interpretation. CONCLUSION The novel DDMC algorithm improved quality of cardiac PET images with motion. Correlation between machine measurement of motion quantification and physician interpretation was significant.
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Affiliation(s)
- Yushui Han
- Houston Methodist Debakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower-Suite 1801, Houston, TX, 77030, USA
| | - Ahmed Ibrahim Ahmed
- Houston Methodist Debakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower-Suite 1801, Houston, TX, 77030, USA
| | | | - Aaron K Jung
- Siemens Medical Solutions USA, Inc., Knoxville, TN, USA
| | - Jean Michel Saad
- Houston Methodist Debakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower-Suite 1801, Houston, TX, 77030, USA
| | | | - Faisal Nabi
- Houston Methodist Debakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower-Suite 1801, Houston, TX, 77030, USA
| | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower-Suite 1801, Houston, TX, 77030, USA.
- Medicine and Cardiology, Weill Cornell Medical College, New York, USA.
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11
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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: 0] [Impact Index Per Article: 0] [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.
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12
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Langaa SS, Mose FH, Fynbo CA, Theil J, Bech JN. Reliability of rubidium-82 PET/CT for renal perfusion determination in healthy subjects. BMC Nephrol 2022; 23:379. [DOI: 10.1186/s12882-022-02962-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Changes in renal perfusion may play a pathophysiological role in hypertension and kidney disease, however to date, no method for renal blood flow (RBF) determination in humans has been implemented in clinical practice. In a previous study, we demonstrated that estimation of renal perfusion based on a single positron emission tomography/computed tomography (PET/CT) scan with Rubidium-82 (82Rb) is feasible and found an approximate 5% intra-assay coefficient of variation for both kidneys, indicative of a precise method.This study’s aim was to determine the day-to day variation of 82Rb PET/CT and to test the method’s ability to detect increased RBF induced by infusion of amino acids.
Methods
Seventeen healthy subjects underwent three dynamic 82Rb PET/CT scans over two examination days comprising: Day A, a single 8-minute dynamic scan and Day B, two scans performed before (baseline) and after RBF stimulation by a 2-hour amino acid-infusion. The order of examination days was determined by randomization. Time activity curves for arterial and renal activity with a 1-tissue compartment model were used for flow estimation; the K1 kinetic parameter representing renal 82Rb clearance. Day-to-day variation was calculated based on the difference between the unstimulated K1 values on Day A and Day B and paired t-testing was performed to compare K1 values at baseline and after RBF stimulation on Day B.
Results
Day-to-day variation was observed to be 5.5% for the right kidney and 6.0% for the left kidney (n = 15 quality accepted scans). K1 values determined after amino acid-infusion were significantly higher than pre-infusion values (n = 17, p = 0.001). The mean percentage change in K1 from baseline was 13.2 ± 12.9% (range − 10.4 to 35.5) for the right kidney; 12.9 ± 13.2% (range − 15.7 to 35.3) for the left kidney.
Conclusion
Day-to-day variation is acceptably low. A significant K1 increase from baseline is detected after application of a known RBF stimulus, indicating that 82Rb PET/CT scanning can provide a precise method for evaluation of RBF and it is able to determine changes herein.
Clinical Trial Registration
EU Clinical Trials Register, 2017-005008-88. Registered 18/01/2018.
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13
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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: 0.5] [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.
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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
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14
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Koenders SS, van Dijk JD, Jager PL, Mouden M, Tegelaar AG, Slump CH, van Dalen JA. Effect of temporal sampling protocols on myocardial blood flow measurements using Rubidium-82 PET. J Nucl Cardiol 2022; 29:1729-1741. [PMID: 33655444 PMCID: PMC9345838 DOI: 10.1007/s12350-021-02555-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND A variety of temporal sampling protocols is used worldwide to measure myocardial blood flow (MBF). Both the length and number of time frames in these protocols may alter MBF and myocardial flow reserve (MFR) measurements. We aimed to assess the effect of different clinically used temporal sampling protocols on MBF and MFR quantification in Rubidium-82 (Rb-82) PET imaging. METHODS We retrospectively included 20 patients referred for myocardial perfusion imaging using Rb-82 PET. A literature search was performed to identify appropriate sampling protocols. PET data were reconstructed using 14 selected temporal sampling protocols with time frames of 5-10 seconds in the first-pass phase and 30-120 seconds in the tissue phase. Rest and stress MBF and MFR were calculated for all protocols and compared to the reference protocol with 26 time frames. RESULTS MBF measurements differed (P ≤ 0.003) in six (43%) protocols in comparison to the reference protocol, with mean absolute relative differences up to 16% (range 5%-31%). Statistically significant differences were most frequently found for protocols with tissue phase time frames < 90 seconds. MFR did not differ (P ≥ 0.11) for any of the protocols. CONCLUSIONS Various temporal sampling protocols result in different MBF values using Rb-82 PET. MFR measurements were more robust to different temporal sampling protocols.
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Affiliation(s)
- S S Koenders
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- Technical Medical Center, University of Twente, Enschede, The Netherlands.
| | - J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - M Mouden
- Department of Cardiology, Isala hospital, Zwolle, The Netherlands
| | - A G Tegelaar
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - C H Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala hospital, Zwolle, The Netherlands
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15
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Frey SM, Honegger U, Clerc OF, Caobelli F, Haaf P, Zellweger MJ. Left ventricular ejection fraction, myocardial blood flow and hemodynamic variables in adenosine and regadenoson vasodilator 82-Rubidium PET. J Nucl Cardiol 2022; 29:921-933. [PMID: 34386864 DOI: 10.1007/s12350-021-02729-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/16/2021] [Indexed: 02/04/2023]
Abstract
AIMS In most Rubidium-(Rb)-positron emission tomography (PET) studies, dipyridamole was used as vasodilator. The aim was to evaluate vasodilator PET left ventricular ejection fraction (LVEF), myocardial blood flow (MBF), hemodynamics, and the influence of adenosine and regadenoson on these variables. METHODS AND RESULTS Consecutive patients (N = 2299) with prior coronary artery disease (CAD) or no prior CAD undergoing adenosine/regadenoson 82Rb-PET were studied and compared according to CAD status and normal/abnormal PET (summed stress score 0-3 vs. ≥4). Rest and stress LVEF differed significantly depending on CAD status and scan results. In patients with no prior CAD, rest/stress LVEF were 68% and 72%, in patients with prior CAD 60% and 63%. LVEF during stress increased 5 ± 6% in normal compared to 1 ± 8% in abnormal PET (P<0.001). Global rest myocardial blood flow(rMBF), stress MBF(sMBF) and myocardial flow reserve (sMBF/rMBF) were significantly higher in no prior CAD patients compared to prior CAD patients(1.3 ± 0.5, 3.3 ± 0.9, 2.6 ± 0.8 and 1.2 ± 0.4, 2.6 ± 0.8, 2.4 ± 0.8 ml/g/min, respectively, P<0.001) and in normal versus abnormal scans, irrespective of CAD status(no prior CAD: 1.4 ± 0.5, 3.5 ± 0.8, 2.8 ± 0.8 and 1.2 ± 0.8, 2.5 ± 0.8, 2.2 ± 0.7; prior CAD: 1.3 ± 0.4, 3.1 ± 0.8, 2.7 ± 0.8 and 1.1 ± 0.4, 2.3 ± 0.7, 2.2 ± 0.7 ml/g/min, respectively, P<0.001). LVEF and hemodynamic values were similar for adenosine and regadenoson stress. Stress LVEF ≥70% excluded relevant ischemia (≥10%) with a negative predictive value (NPV) of 94% (CI 92-95%). CONCLUSIONS Rest/stress LVEF, LVEF reserve and MBF values are lower in abnormal compared to normal scans. Adenosine and regadenoson seem to have similar effect on stress LVEF, MBF and hemodynamics. A stress LVEF ≥70% has a high NPV to exclude relevant ischemia.
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Affiliation(s)
- Simon M Frey
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ursina Honegger
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Olivier F Clerc
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Federico Caobelli
- Department of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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16
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Crișan G, Moldovean-Cioroianu NS, Timaru DG, Andrieș G, Căinap C, Chiș V. Radiopharmaceuticals for PET and SPECT Imaging: A Literature Review over the Last Decade. Int J Mol Sci 2022; 23:ijms23095023. [PMID: 35563414 PMCID: PMC9103893 DOI: 10.3390/ijms23095023] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Positron emission tomography (PET) uses radioactive tracers and enables the functional imaging of several metabolic processes, blood flow measurements, regional chemical composition, and/or chemical absorption. Depending on the targeted processes within the living organism, different tracers are used for various medical conditions, such as cancer, particular brain pathologies, cardiac events, and bone lesions, where the most commonly used tracers are radiolabeled with 18F (e.g., [18F]-FDG and NA [18F]). Oxygen-15 isotope is mostly involved in blood flow measurements, whereas a wide array of 11C-based compounds have also been developed for neuronal disorders according to the affected neuroreceptors, prostate cancer, and lung carcinomas. In contrast, the single-photon emission computed tomography (SPECT) technique uses gamma-emitting radioisotopes and can be used to diagnose strokes, seizures, bone illnesses, and infections by gauging the blood flow and radio distribution within tissues and organs. The radioisotopes typically used in SPECT imaging are iodine-123, technetium-99m, xenon-133, thallium-201, and indium-111. This systematic review article aims to clarify and disseminate the available scientific literature focused on PET/SPECT radiotracers and to provide an overview of the conducted research within the past decade, with an additional focus on the novel radiopharmaceuticals developed for medical imaging.
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Affiliation(s)
- George Crișan
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | | | - Diana-Gabriela Timaru
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
| | - Gabriel Andrieș
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Călin Căinap
- The Oncology Institute “Prof. Dr. Ion Chiricuţă”, Republicii 34-36, 400015 Cluj-Napoca, Romania;
| | - Vasile Chiș
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Institute for Research, Development and Innovation in Applied Natural Sciences, Babeș-Bolyai University, Str. Fântânele 30, 400327 Cluj-Napoca, Romania
- Correspondence:
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17
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Nesterov SV, Knuuti JM. 82Rb-PET MPQ: Do normal values exist? J Nucl Cardiol 2022; 29:474-475. [PMID: 33000406 DOI: 10.1007/s12350-020-02362-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Sergey V Nesterov
- Turku PET Centre, University of Turku, Turku, Finland.
- Institute of Evolutionary Physiology and Biochemistry RAS, St. Petersburg, Russia.
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18
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Freitag MT, Bremerich J, Wild D, Haaf P, Zellweger MJ, Caobelli F. Quantitative myocardial perfusion 82Rb-PET assessed by hybrid PET/coronary-CT: Normal values and diagnostic performance. J Nucl Cardiol 2022; 29:464-473. [PMID: 32676910 DOI: 10.1007/s12350-020-02264-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to assess normal values for quantified myocardial blood flow (MBF) on a hybrid PET/coronary-CT scanner and to test their diagnostic performance in patients with suspected CAD. MATERIALS AND METHODS Patients underwent 82Rb-PET/CT and integrated CT-based coronary angiography (CCTA) and were classified as normal (no stenosis), with non-obstructive stenosis (< 50%) and with CAD (≥ 50%). Global and regional stress MBF (sMBF), rest MBF and myocardial flow reserve (MFR) were calculated. Ischemia was defined as SDS ≥ 2, severe ischemia as SDS ≥ 7. RESULTS 357 consecutive patients were included. Global sMBF and MFR were higher in normal patients than in patients with CAD (3.61 ± 0.71 vs 3.04 ± 0.77, P < 0.0001; 3.08 ± 0.84 vs 2.68 ± 0.79, P = 0.0001), but not different compared to patients with non-obstructive stenosis (3.61 ± 0.71 vs 3.43 ± 0.69, P = 0.052; 3.08 ± 0.84 vs 2.99 ± 0.82, P = 0.45). sMBF yielded superior accuracy over MFR in identifying both ischemia (AUC 0.74 vs 0.62, P = 0.003) and severe ischemia (AUC 0.88 vs 0.78, P = 0.012). Optimal threshold for global sMBF to rule out myocardial ischemia was 3.5 mL g-1 min-1. CONCLUSIONS Normal quantitative values are provided. Global sMBF provided higher diagnostic accuracy than MFR. Using sMBF-threshold of 3.5 mL·g-1·min-1 on 82Rb-PET/CT yielded similar NPV (96%) as CCTA to rule out CAD. Hence, resting scan could be omitted in patients with sMBF values above reference.
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Affiliation(s)
- Martin T Freitag
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Jens Bremerich
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Damian Wild
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Philip Haaf
- Clinic of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Federico Caobelli
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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19
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Nesterov SV, Deshayes E, Juarez-Orozco LE, deKemp RA, Sciagrà R, Malaspina S, Settimo L, Han C, Ryzhkova DV, Kostina IS, Gwet KL, Prior JO, Knuuti JM. Myocardial perfusion quantification with Rb-82 PET: good interobserver agreement of Carimas software on global, regional, and segmental levels. Ann Nucl Med 2022; 36:507-514. [PMID: 35192160 PMCID: PMC9132838 DOI: 10.1007/s12149-022-01729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/09/2022] [Indexed: 12/04/2022]
Abstract
Purpose To estimate the interobserver agreement of the Carimas software package (SP) on global, regional, and segmental levels for the most widely used myocardial perfusion PET tracer—Rb-82. Materials and methods Rest and stress Rb-82 PET scans of 48 patients with suspected or known coronary artery disease (CAD) were analyzed in four centers using the Carimas SP. We considered values to agree if they simultaneously had an intraclass correlation coefficient (ICC) > 0.75 and a difference < 20% of the median across all observers. Results The median values on the segmental level were 1.08 mL/min/g for rest myocardial blood flow (MBF), 2.24 mL/min/g for stress MBF, and 2.17 for myocardial flow reserve (MFR). For the rest MBF and MFR, all the values at all the levels fulfilled were in excellent agreement. For stress MBF, at the global and regional levels, all the 24 comparisons showed excellent agreement. Only 1 out of 102 segmental comparisons (seg. 14) was over the adequate agreement limit—23.5% of the median value (ICC = 0.95). Conclusion Interobserver agreement for Rb-82 PET myocardial perfusion quantification analyzed with Carimas is good at any LV segmentation level—global, regional, and segmental. It is good for all the estimates—rest MBF, stress MBF, and MFR.
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Affiliation(s)
- Sergey V Nesterov
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland. .,IM Sechenov Institute of Evolutionary Physiology and Biochemistry RAS, Saint Petersburg, Russia.
| | - Emmanuel Deshayes
- University of Lausanne, Lausanne, Switzerland.,Regional Cancer Institute of Montpellier (ICM)-Val d'Aurelle, Montpellier, France
| | | | - Robert A deKemp
- National Cardiac PET Center, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Simona Malaspina
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Chunlei Han
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Darja V Ryzhkova
- Almazov Federal Heart, Blood and Endocrinology Centre, Saint Petersburg, Russia
| | - Irina S Kostina
- Almazov Federal Heart, Blood and Endocrinology Centre, Saint Petersburg, Russia
| | | | | | - Juhani M Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
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20
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Patel KK, Patel FS, Bateman TM, Kennedy KF, Peri-Okonny PA, McGhie AI, Sperry BW, Shaw L, Carli MD, Thompson RC, Saeed IM, Jones PG, Spertus JA. Relationship Between Myocardial Perfusion Imaging Abnormalities on Positron Emission Tomography and Anginal Symptoms, Functional Status, and Quality of Life. Circ Cardiovasc Imaging 2022; 15:e013592. [PMID: 35167313 PMCID: PMC8869837 DOI: 10.1161/circimaging.121.013592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) identifies abnormalities that occur early in the ischemic cascade leading to angina. Our aim was to study the association between ischemic measures on positron emission tomography MPI and patients' health status; their symptoms, function, and quality of life. METHODS Health status was collected using the Seattle Angina Questionnaire (SAQ-7, 0-100, higher=better) and Rose Dyspnea Score (RDS) on 1515 outpatients with known or suspected coronary artery disease presenting for clinically indicated pharmacological 82Rb positron emission tomography MPI from July 2018 to July 2019. Adjusted multivariable ordinal regression models were used to assess the association between MPI findings of ischemia and the SAQ physical limitation, angina frequency, quality of life, summary score, and the RDS. RESULTS The mean SAQ and RDS scores of the cohort (mean age 71.7 years, 55% male, 37.6% prior myocardial infarction or revascularization) were 73.8±28.6 (physical limitation), 87.4±21.7 (angina frequency), 79.0±26.1 (quality of life), 81.3±19.0 (summary score), and 2±2 (RDS). No perfusion, flow or function abnormalities were significantly associated with SAQ angina frequency scores. Low left ventricular ejection fraction reserve (≤0%), low global and regional myocardial blood flow reserve (<2) were independently associated with worse SAQ Physical Limitation score, SAQ summary score, and RDS (30% to 57% greater odds; all P≤0.01), but reversible perfusion defects were not. CONCLUSIONS Impaired augmentation of left ventricular ejection fraction and myocardial blood flow with stress is associated with significant angina-associated functional limitation, health status, and dyspnea in patients who underwent positron emission tomography MPI, but not the frequency of their angina. Future studies should evaluate whether therapies that improve stress-induced abnormalities in systolic function and myocardial flow may improve patients' health status.
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Affiliation(s)
- Krishna K. Patel
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Timothy M. Bateman
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Poghni A. Peri-Okonny
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - A. Iain McGhie
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Brett W. Sperry
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Leslee Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marcelo Di Carli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Randall C. Thompson
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Ibrahim M. Saeed
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - John A. Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
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21
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Rubidium-82 PET/CT myocardial perfusion imaging. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Werner RA, Pomper MG, Buck AK, Rowe SP, Higuchi T. SPECT and PET Radiotracers in Renal Imaging. Semin Nucl Med 2022; 52:406-418. [DOI: 10.1053/j.semnuclmed.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
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Yang B, Wang X, Li A, Moody JB, Tang J. Dictionary Learning Constrained Direct Parametric Estimation in Dynamic Myocardial Perfusion PET. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3485-3497. [PMID: 34125672 DOI: 10.1109/tmi.2021.3089112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In myocardial perfusion imaging with dynamic positron emission tomography (PET), direct parametric reconstruction from the projection data allows accurate modeling of the Poisson noise in the projection domain to provide more reliable estimate of the parametric images. In this study, we propose to incorporate a superior denoiser to efficiently suppress the unfavorable noise propagation during the direct reconstruction. The dictionary learning (DL) based sparse representation serves as a regularization term to constrain the intermediate K1 estimation. We rewrite the DL regularizer into a voxel-separable form to facilitate the decoupling of a DL penalized curve fitting from the reconstruction of dynamic frames. The nonlinear fitting is then solved by a damped Newton method with uniform initialization. Using simulated and patient 82Rb dynamic PET data, we study the performance of the proposed DL direct algorithm and quantitatively compare it with the indirect method with or without post-filtering, the direct reconstruction without regularization, and the quadratic penalty regularized direct algorithm. The DL regularized direct reconstruction achieves improved noise versus bias performance in the reconstructed K1 images as well as superior recovery of a reduced myocardial blood flow defect. The dictionary learned from a 3D self-created hollow sphere image yields comparable results to those using the dictionary learned from the corresponding magnetic resonance image. The uniform initializations converge to K1 estimations similar to the result from initializing with the indirect reconstruction. To summarize, we demonstrate the potential of the proposed DL constrained direct parametric reconstruction in improving quantitative dynamic PET imaging.
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Shi L, Lu Y, Dvornek N, Weyman CA, Miller EJ, Sinusas AJ, Liu C. Automatic Inter-Frame Patient Motion Correction for Dynamic Cardiac PET Using Deep Learning. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3293-3304. [PMID: 34018932 PMCID: PMC8670362 DOI: 10.1109/tmi.2021.3082578] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patient motion during dynamic PET imaging can induce errors in myocardial blood flow (MBF) estimation. Motion correction for dynamic cardiac PET is challenging because the rapid tracer kinetics of 82Rb leads to substantial tracer distribution change across different dynamic frames over time, which can cause difficulties for image registration-based motion correction, particularly for early dynamic frames. In this paper, we developed an automatic deep learning-based motion correction (DeepMC) method for dynamic cardiac PET. In this study we focused on the detection and correction of inter-frame rigid translational motion caused by voluntary body movement and pattern change of respiratory motion. A bidirectional-3D LSTM network was developed to fully utilize both local and nonlocal temporal information in the 4D dynamic image data for motion detection. The network was trained and evaluated over motion-free patient scans with simulated motion so that the motion ground-truths are available, where one million samples based on 65 patient scans were used in training, and 600 samples based on 20 patient scans were used in evaluation. The proposed method was also evaluated using additional 10 patient datasets with real motion. We demonstrated that the proposed DeepMC obtained superior performance compared to conventional registration-based methods and other convolutional neural networks (CNN), in terms of motion estimation and MBF quantification accuracy. Once trained, DeepMC is much faster than the registration-based methods and can be easily integrated into the clinical workflow. In the future work, additional investigation is needed to evaluate this approach in a clinical context with realistic patient motion.
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25
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Gewirtz H. PET 18F-flurpridaz quantitative measurements of myocardial blood flow: Added value for diagnosis of coronary artery disease? Of course! J Nucl Cardiol 2021; 28:2330-2334. [PMID: 32020502 DOI: 10.1007/s12350-020-02043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Henry Gewirtz
- Department of Medicine (Cardiology Division), Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
- Cardiac Unit, Massachusetts General Hospital, Boston, MA, 02114, USA.
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26
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Kero T, Johansson E, Engström M, Eggers KM, Johansson L, Ahlström H, Lubberink M. Evaluation of quantitative CMR perfusion imaging by comparison with simultaneous 15O-water-PET. J Nucl Cardiol 2021; 28:1252-1266. [PMID: 31313066 PMCID: PMC8421320 DOI: 10.1007/s12350-019-01810-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We assessed the quantitative accuracy of cardiac perfusion measurements using dynamic contrast-enhanced MRI with simultaneous 15O-water PET as reference with a fully integrated PET-MR scanner. METHODS 15 patients underwent simultaneous DCE MRI and 15O-water PET scans at rest and adenosine-stress on an integrated PET-MR scanner. Correlation and agreement between MRI- and PET-based global and regional MBF values were assessed using correlation and Bland-Altman analysis. RESULTS Three subjects were excluded due to technical problems. Global mean (± SD) MBF values at rest and stress were 0.97 ± 0.27 and 3.19 ± 0.70 mL/g/min for MRI and 1.02 ± 0.28 and 3.13 ± 1.16 mL/g/min for PET (P = 0.66 and P = 0.81). The correlations between global and regional MRI- and PET-based MBF values were strong (r = 0.86 and r = 0.75). The biases were negligible for both global and regional MBF comparisons (0.01 and 0.00 mL/min/g for both), but the limits of agreement were wide for both global and regional MBF, with larger variability for high MBF-values. CONCLUSION The correlation between simultaneous MBF measurements with DCE MRI and 15O-water PET measured in an integrated PET-MRI was strong but the agreement was only moderate indicating that MRI-based quantitative MBF measurements is not ready for clinical introduction.
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Affiliation(s)
- Tanja Kero
- Medical Imaging Centre, Uppsala University Hospital, 75185, Uppsala, Sweden.
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | | | | | - Kai M Eggers
- Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Håkan Ahlström
- Medical Imaging Centre, Uppsala University Hospital, 75185, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
- Antaros Medical, BioVenture Hub, Mölndal, Sweden
| | - Mark Lubberink
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
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27
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Langaa SS, Lauridsen TG, Mose FH, Fynbo CA, Theil J, Bech JN. Estimation of renal perfusion based on measurement of rubidium-82 clearance by PET/CT scanning in healthy subjects. EJNMMI Phys 2021; 8:43. [PMID: 34057645 PMCID: PMC8167076 DOI: 10.1186/s40658-021-00389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Changes in renal blood flow (RBF) may play a pathophysiological role in hypertension and kidney disease. However, RBF determination in humans has proven difficult. We aimed to confirm the feasibility of RBF estimation based on positron emission tomography/computed tomography (PET/CT) and rubidium-82 (82Rb) using the abdominal aorta as input function in a 1-tissue compartment model. Methods Eighteen healthy subjects underwent two dynamic 82Rb PET/CT scans in two different fields of view (FOV). FOV-A included the left ventricular blood pool (LVBP), the abdominal aorta (AA) and the majority of the kidneys. FOV-B included AA and the kidneys in their entirety. In FOV-A, an input function was derived from LVBP and from AA, in FOV-B from AA. One-tissue compartmental modelling was performed using tissue time activity curves generated from volumes of interest (VOI) contouring the kidneys, where the renal clearance of 82Rb is represented by the K1 kinetic parameter. Total clearance for both kidneys was calculated by multiplying the K1 values with the volume of VOIs used for analysis. Intra-assay coefficients of variation and inter-observer variation were calculated. Results For both kidneys, K1 values derived from AA did not differ significantly from values obtained from LVBP, neither were significant differences seen between AA in FOV-A and AA in FOV-B, nor between the right and left kidneys. For both kidneys, the intra-assay coefficients of variation were low (~ 5%) for both input functions. The measured K1 of 2.80 ml/min/cm3 translates to a total clearance for both kidneys of 766 ml/min/1.73 m2. Conclusion Measurement of renal perfusion based on PET/CT and 82Rb using AA as input function in a 1-tissue compartment model is feasible in a single FOV. Based on previous studies showing 82Rb to be primarily present in plasma, the measured K1 clearance values are most likely representative of effective renal plasma flow (ERPF) rather than estimated RBF values, but as the accurate calculation of total clearance/flow is very much dependent on the analysed volume, a standardised definition for the employed renal volumes is needed to allow for proper comparison with standard ERPF and RBF reference methods. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00389-0.
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Affiliation(s)
- Stine Sundgaard Langaa
- Gødstrup HospitalUniversity Clinic in Nephrology and Hypertension, Department of Medical Research, Gødstrup Hospital and Aarhus University, Lægaardvej 12J, 7500, Holstebro, Denmark.
| | - Thomas Guldager Lauridsen
- Gødstrup HospitalUniversity Clinic in Nephrology and Hypertension, Department of Medical Research, Gødstrup Hospital and Aarhus University, Lægaardvej 12J, 7500, Holstebro, Denmark
| | - Frank Holden Mose
- Gødstrup HospitalUniversity Clinic in Nephrology and Hypertension, Department of Medical Research, Gødstrup Hospital and Aarhus University, Lægaardvej 12J, 7500, Holstebro, Denmark
| | | | - Jørn Theil
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jesper Nørgaard Bech
- Gødstrup HospitalUniversity Clinic in Nephrology and Hypertension, Department of Medical Research, Gødstrup Hospital and Aarhus University, Lægaardvej 12J, 7500, Holstebro, Denmark
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Gaudieri V, Mannarino T, Zampella E, Assante R, D'Antonio A, Nappi C, Cantoni V, Green R, Petretta M, Arumugam P, Cuocolo A, Acampa W. Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease. Eur J Nucl Med Mol Imaging 2021; 48:3162-3171. [PMID: 33594472 PMCID: PMC8426234 DOI: 10.1007/s00259-021-05239-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022]
Abstract
Purpose The identification of coronary vascular dysfunction may enhance risk stratification in patients with resistant hypertension (RH). We evaluated if impaired coronary vascular function, assessed by rubidium-82 (82Rb) positron emission tomography/computed tomography (PET/CT) imaging, is associated with increased cardiovascular risk in patients with hypertension without overt coronary artery disease (CAD). Methods We studied 517 hypertensive subjects, 26% with RH, without overt CAD, and with normal stress-rest myocardial perfusion imaging at 82Rb PET/CT. The outcome end points were cardiac death, nonfatal myocardial infarction, coronary revascularization, and admission for heart failure. Results Over a median of 38 months (interquartile range 26 to 50), 21 cardiac events (4.1% cumulative event rate) occurred. Patients with RH were older (p < 0.05) and had a higher prevalence of left ventricular hypertrophy (p < 0.001), a lower hyperemic myocardial blood flow (MBF), and myocardial perfusion reserve (MPR) (both p < 0.001) compared to those without. Conversely, coronary artery calcium content and baseline MBF were not different between patients with and without RH. At univariable Cox regression analysis, age, RH, left ventricular ejection fraction, coronary artery calcium score, and reduced MPR were significant predictors of events. At multivariable analysis, age, RH, and reduced MPR (all p < 0.05) were independent predictors of events. Patients with RH and reduced MPR had the highest risk of events and the major risk acceleration over time. Conclusion The findings suggest that the assessment of coronary vascular function may enhance risk stratification in patients with hypertension.
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Affiliation(s)
- Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UK
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy. .,Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
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Lu Y, Liu C. Patient motion correction for dynamic cardiac PET: Current status and challenges. J Nucl Cardiol 2020; 27:1999-2002. [PMID: 30421380 DOI: 10.1007/s12350-018-01513-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Yihuan Lu
- Department of Radiology and Biomedical Imaging, Yale University, 789 Howard Ave., New Haven, CT, 06519-1368, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, 789 Howard Ave., New Haven, CT, 06519-1368, USA.
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30
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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31
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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: 1] [Impact Index Per Article: 0.3] [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
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32
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Moody JB, Hiller KM, Lee BC, Poitrasson-Rivière A, Corbett JR, Weinberg RL, Murthy VL, Ficaro EP. The utility of 82Rb PET for myocardial viability assessment: Comparison with perfusion-metabolism 82Rb- 18F-FDG PET. J Nucl Cardiol 2019; 26:374-386. [PMID: 30809755 DOI: 10.1007/s12350-019-01615-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/01/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND 82Rb kinetics may distinguish scar from viable but dysfunctional (hibernating) myocardium. We sought to define the relationship between 82Rb kinetics and myocardial viability compared with conventional 82Rb and 18F-fluorodeoxyglucose (FDG) perfusion-metabolism PET imaging. METHODS Consecutive patients (N = 120) referred for evaluation of myocardial viability prior to revascularization and normal volunteers (N = 37) were reviewed. Dynamic 82Rb 3D PET data were acquired at rest. 18F-FDG 3D PET data were acquired after metabolic preparation using a standardized hyperinsulinemic-euglycemic clamp. 82Rb kinetic parameters K1, k2, and partition coefficient (KP) were estimated by compartmental modeling RESULTS: Segmental 82Rb k2 and KP differed significantly between scarred and hibernating segments identified by Rb-FDG perfusion-metabolism (k2, 0.42 ± 0.25 vs. 0.22 ± 0.09 min-1; P < .0001; KP, 1.33 ± 0.62 vs. 2.25 ± 0.98 ml/g; P < .0001). As compared to Rb-FDG analysis, segmental Rb KP had a c-index, sensitivity and specificity of 0.809, 76% and 84%, respectively, for distinguishing hibernating and scarred segments. Segmental k2 performed similarly, but with lower specificity (75%, P < .001) CONCLUSIONS: In this pilot study, 82Rb kinetic parameters k2 and KP, which are readily estimated using a compartmental model commonly used for myocardial blood flow, reliably differentiated hibernating myocardium and scar. Further study is necessary to evaluate their clinical utility for predicting benefit after revascularization.
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Affiliation(s)
- Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA.
| | - Keri M Hiller
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin C Lee
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA
| | | | - James R Corbett
- 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
| | - Richard L Weinberg
- 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
| | - 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
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, 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
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Mohy-Ud-Din H, Boutagy NE, Stendahl JC, Zhuang ZW, Sinusas AJ, Liu C. Quantification of intramyocardial blood volume with 99mTc-RBC SPECT-CT imaging: A preclinical study. J Nucl Cardiol 2018; 25:2096-2111. [PMID: 28695406 PMCID: PMC5985225 DOI: 10.1007/s12350-017-0970-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Currently, there is no established non-invasive imaging approach to directly evaluate myocardial microcirculatory function in order to diagnose microvascular disease independent of co-existing epicardial disease. In this work, we developed a methodological framework for quantification of intramyocardial blood volume (IMBV) as a novel index of microcirculatory function with SPECT/CT imaging of 99mTc-labeled red blood cells (RBCs). METHODS Dual-gated myocardial SPECT/CT equilibrium imaging of 99mTc-RBCs was performed on twelve canines under resting conditions. Five correction schemes were studied: cardiac gating with no other corrections (CG), CG with attenuation correction (CG + AC), CG + AC with scatter correction (CG + AC + SC), dual cardiorespiratory gating with AC + SC (DG + AC + SC), and DG + AC + SC with partial volume correction (DG + AC + SC + PVC). Quantification of IMBV using each approach was evaluated in comparison to those obtained from all corrections. The in vivo SPECT estimates of IMBV values were validated against those obtained from ex vivo microCT imaging of the casted hearts. RESULTS The estimated IMBV with all corrections was 0.15 ± 0.03 for the end-diastolic phase and 0.11 ± 0.03 for the end-systolic phase. The cycle-dependent change in IMBV (ΔIMBV) with all corrections was 23.9 ± 8.6%. Schemes that applied no correction or partial correction resulted in significant over-estimation of IMBV and significant under-underestimation of ΔIMBV. Estimates of IMBV and ΔIMBV using all corrections were consistent with values reported in the literature using invasive techniques. In vivo SPECT estimates of IMBV strongly correlated (R2 ≥ 0.70) with ex vivo measures for the various correction schemes, while the fully corrected scheme yielded the smallest bias. CONCLUSIONS Non-invasive quantification of IMBV is feasible using 99mTc-RBCs SPECT/CT imaging, however, requires full compensation of physical degradation factors.
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Affiliation(s)
- Hassan Mohy-Ud-Din
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
- Shaukat Khanum Memorial Cancer Hospital and Research Center, 7-A, Block R-3, Johar Town, Lahore, 54000, Pakistan.
| | - Nabil E Boutagy
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John C Stendahl
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Zhen W Zhuang
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
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Eck BL, Muzic RF, Levi J, Wu H, Fahmi R, Li Y, Fares A, Vembar M, Dhanantwari A, Bezerra HG, Wilson DL. The role of acquisition and quantification methods in myocardial blood flow estimability for myocardial perfusion imaging CT. Phys Med Biol 2018; 63:185011. [PMID: 30113311 PMCID: PMC6264889 DOI: 10.1088/1361-6560/aadab6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work, we clarified the role of acquisition parameters and quantification methods in myocardial blood flow (MBF) estimability for myocardial perfusion imaging using CT (MPI-CT). We used a physiologic model with a CT simulator to generate time-attenuation curves across a range of imaging conditions, i.e. tube current-time product, imaging duration, and temporal sampling, and physiologic conditions, i.e. MBF and arterial input function width. We assessed MBF estimability by precision (interquartile range of MBF estimates) and bias (difference between median MBF estimate and reference MBF) for multiple quantification methods. Methods included: six existing model-based deconvolution models, such as the plug-flow tissue uptake model (PTU), Fermi function model, and single-compartment model (SCM); two proposed robust physiologic models (RPM1, RPM2); model-independent singular value decomposition with Tikhonov regularization determined by the L-curve criterion (LSVD); and maximum upslope (MUP). Simulations show that MBF estimability is most affected by changes in imaging duration for model-based methods and by changes in tube current-time product and sampling interval for model-independent methods. Models with three parameters, i.e. RPM1, RPM2, and SCM, gave least biased and most precise MBF estimates. The average relative bias (precision) for RPM1, RPM2, and SCM was ⩽11% (⩽10%) and the models produced high-quality MBF maps in CT simulated phantom data as well as in a porcine model of coronary artery stenosis. In terms of precision, the methods ranked best-to-worst are: RPM1 > RPM2 > Fermi > SCM > LSVD > MUP [Formula: see text] other methods. In terms of bias, the models ranked best-to-worst are: SCM > RPM2 > RPM1 > PTU > LSVD [Formula: see text] other methods. Models with four or more parameters, particularly five-parameter models, had very poor precision (as much as 310% uncertainty) and/or significant bias (as much as 493%) and were sensitive to parameter initialization, thus suggesting the presence of multiple local minima. For improved estimates of MBF from MPI-CT, it is recommended to use reduced models that incorporate prior knowledge of physiology and contrast agent uptake, such as the proposed RPM1 and RPM2 models.
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Affiliation(s)
- Brendan L Eck
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
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35
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Taillefer R, Harel F. Radiopharmaceuticals for cardiac imaging: Current status and future trends. J Nucl Cardiol 2018; 25:1242-1246. [PMID: 29417412 DOI: 10.1007/s12350-018-1194-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Raymond Taillefer
- Département d'imagerie médicale, Hôpital du Haut-Richelieu du CISSS Montérégie-Centre, Saint-Jean-sur-Richelieu, QC, Canada.
| | - Francois Harel
- Département d'imagerie médicale, Institut de Cardiologie de Montréal, Montreal, QC, Canada
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36
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Memmott MJ, Tonge CM, Saint KJ, Arumugam P. Impact of pharmacological stress agent on patient motion during rubidium-82 myocardial perfusion PET/CT. J Nucl Cardiol 2018; 25:1286-1295. [PMID: 28054183 DOI: 10.1007/s12350-016-0767-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient motion has been demonstrated to have a significant impact on the quality and accuracy of rubidium-82 myocardial perfusion PET/CT. This study aimed to investigate the effect on patient motion of two pharmacological stressing agents, adenosine and regadenoson. METHODS AND RESULTS Dynamic data were retrospectively analyzed in 90 patients undergoing adenosine (n = 30), incremental adenosine (n = 30), or regadenoson (n = 30) rubidium-82 myocardial perfusion PET/CT. Severity of motion was scored qualitatively using a four-point (0-3) scale and quantitatively using frame-to-frame pixel shifts. The type of motion, returning or non-returning, and the frame in which it occurred were also recorded. There were significant differences in both the qualitative and quantitative scores comparing regadenoson to adenosine (P = .025 and P < .001) and incremental adenosine (P = .014, P = .015), respectively. The difference in scores between adenosine and incremental adenosine was not significant. Where motion was present, significantly more adenosine patients were classed as non-returning (P = .018). The median frames for motion occurring were 12 for regadenoson and 14 for both adenosine cohorts. CONCLUSIONS The choice of stressing protocol impacts significantly on patient motion. Patients stressed with regadenoson have significantly lower motion scores than those stressed with adenosine, using local protocols. This motion is more likely to be associated with a drift of the heart away from a baseline position, coinciding with the termination of infusion.
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Affiliation(s)
- Matthew J Memmott
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, United Kingdom.
| | - Christine M Tonge
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - Kimberley J Saint
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - Parthiban Arumugam
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, United Kingdom
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37
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Pryds K, Nielsen RR, Hoff CM, Tolbod LP, Bouchelouche K, Li J, Schmidt MR, Redington AN, Frøkiær J, Bøtker HE. Effect of remote ischemic conditioning on myocardial perfusion in patients with suspected ischemic coronary artery disease. J Nucl Cardiol 2018; 25:887-896. [PMID: 27804070 DOI: 10.1007/s12350-016-0709-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/30/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Remote ischemic conditioning (RIC) confers protection against myocardial ischemia-reperfusion injury and may modulate coronary blood flow. We investigated whether RIC affects resting myocardial perfusion (MP) in patients with suspected ischemic coronary artery disease by quantitative MP imaging. METHODS AND RESULTS We included 49 patients with suspected ischemic coronary artery disease. Resting MP was quantified by 82Rubidium positron emission tomography/computed tomography (82Rb-PET/CT) imaging before and after RIC, performed as four cycles of 5 minutes upper arm ischemia and reperfusion. Subsequent adenosine 82Rb-PET/CT stress-imaging identified non-ischemic and reversibly ischemic myocardial segments. MicroRNA-144 plasma levels were measured before and after RIC. Normalized for rate pressure product, RIC did not affect MP globally (P = .64) or in non-ischemic myocardial segments (P = .58) but decreased MP in reversibly ischemic myocardial segments (-0.11 mL/min/g decrease in MP following RIC; 95% CI -0.17 to -0.06, P < .001). However, we found no effect of RIC when MP was normalized for cardiac work. MicroRNA-144 plasma levels increased following RIC (P = .006) but did not correlate with a change in global MP in response to RIC (P = .40). CONCLUSIONS RIC did not substantially affect resting MP globally or in non-ischemic and reversibly ischemic myocardial territories in patients with suspected ischemic coronary artery disease.
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Affiliation(s)
- Kasper Pryds
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
| | - Roni Ranghøj Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Camilla Molich Hoff
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Jing Li
- Division of Cardiology, Labatt Family Heart Center, Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Rahbek Schmidt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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38
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Assessment of myocardial blood flow and coronary flow reserve with positron emission tomography in ischemic heart disease: current state and future directions. Heart Fail Rev 2018; 22:441-453. [PMID: 28593557 DOI: 10.1007/s10741-017-9625-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Positron emission tomography (PET) is a versatile imaging technology that allows assessment of myocardial perfusion, both at a spatially relative scale and also in absolute terms, thereby enabling noninvasive evaluation of myocardial blood flow (MBF) and coronary flow reserve (CFR). Assessment of MBF using FDA-approved PET isotopes, such as 82Rb and 13N-ammonia, has been well validated, and several software packages are currently available, thereby allowing for MBF evaluation to be incorporated into routine workflow in contemporary nuclear laboratories. Incremental diagnostic and prognostic information provided with the knowledge of MBF has the potential for widespread applications. Improving the ability to identify the true burden of obstructive epicardial coronary stenoses and allowing for noninvasive assessment of coronary micro circulatory function can be achieved with MBF assessment. On the other hand, attenuated CFR has been shown to predict adverse cardiovascular prognosis in a variety of clinical settings and patient subgroups. With expanding applications of MBF, this tool promises to provide unique insight into the integrity of the entire coronary vascular bed beyond what is currently available with relative perfusion assessment. This review intends to provide an in-depth discussion of technical and clinical aspects of MBF assessment with PET as it relates to patients with ischemic heart disease.
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39
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Yoshinaga K, Manabe O, Tamaki N. Absolute quantification of myocardial blood flow. J Nucl Cardiol 2018; 25:635-651. [PMID: 27444500 DOI: 10.1007/s12350-016-0591-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/01/2016] [Indexed: 12/22/2022]
Abstract
With the increasing availability of positron emission tomography (PET) myocardial perfusion imaging, the absolute quantification of myocardial blood flow (MBF) has become popular in clinical settings. Quantitative MBF provides an important additional diagnostic or prognostic information over conventional visual assessment. The success of MBF quantification using PET/computed tomography (CT) has increased the demand for this quantitative diagnostic approach to be more accessible. In this regard, MBF quantification approaches have been developed using several other diagnostic imaging modalities including single-photon emission computed tomography, CT, and cardiac magnetic resonance. This review will address the clinical aspects of PET MBF quantification and the new approaches to MBF quantification.
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Affiliation(s)
- Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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40
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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: 133] [Impact Index Per Article: 22.2] [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
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41
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Guo R, Petibon Y, Ma Y, El Fakhri G, Ying K, Ouyang J. MR-based motion correction for cardiac PET parametric imaging: a simulation study. EJNMMI Phys 2018; 5:3. [PMID: 29388075 PMCID: PMC5792384 DOI: 10.1186/s40658-017-0200-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Both cardiac and respiratory motions bias the kinetic parameters measured by dynamic PET. The aim of this study was to perform a realistic positron emission tomography-magnetic resonance (PET-MR) simulation study using 4D XCAT to evaluate the impact of MR-based motion correction on the estimation of PET myocardial kinetic parameters using PET-MR. Dynamic activity distributions were obtained based on a one-tissue compartment model with realistic kinetic parameters and an arterial input function. Realistic proton density/T1/T2 values were also defined for the MRI simulation. Two types of motion patterns, cardiac motion only (CM) and both cardiac and respiratory motions (CRM), were generated. PET sinograms were obtained by the projection of the activity distributions. PET image for each time frame was obtained using static (ST), gated (GA), non-motion-corrected (NMC), and motion-corrected (MC) methods. Voxel-wise unweighted least squares fitting of the dynamic PET data was then performed to obtain K1 values for each study. For each study, the mean and standard deviation of K1 values were computed for four regions of interest in the myocardium across 25 noise realizations. RESULTS Both cardiac and respiratory motions introduce blurring in the PET parametric images if the motion is not corrected. Conventional cardiac gating is limited by high noise level on parametric images. Dual cardiac and respiratory gating further increases the noise level. In contrast to GA, the MR-based MC method reduces motion blurring in parametric images without increasing noise level. It also improves the myocardial defect delineation as compared to NMC method. Finally, the MR-based MC method yields lower bias and variance in K1 values than NMC and GA, respectively. The reductions of K1 bias by MR-based MC are 7.7, 5.1, 15.7, and 29.9% in four selected 0.18-mL myocardial regions of interest, respectively, as compared to NMC for CRM. MR-based MC yields 85.9, 75.3, 71.8, and 95.2% less K1 standard deviation in the four regions, respectively, as compared to GA for CRM. CONCLUSIONS This simulation study suggests that the MR-based motion-correction method using PET-MR greatly reduces motion blurring on parametric images and yields less K1 bias without increasing noise level.
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Affiliation(s)
- Rong Guo
- Department of Engineering Physics, Tsinghua University, Beijing, 10084, China.,Key Laboratory of Particle and Radiation Imaging, Ministry of Education, Beijing, 10084, China.,Present Address: Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Yoann Petibon
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Yixin Ma
- Department of Engineering Physics, Tsinghua University, Beijing, 10084, China.,Key Laboratory of Particle and Radiation Imaging, Ministry of Education, Beijing, 10084, China.,Present Address: Medical Physics Graduate Program, Duke University, Durham, NC, 27705, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Kui Ying
- Department of Engineering Physics, Tsinghua University, Beijing, 10084, China.,Key Laboratory of Particle and Radiation Imaging, Ministry of Education, Beijing, 10084, China
| | - Jinsong Ouyang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA. .,Department of Radiology, Harvard Medical School, Boston, MA, 02115, USA.
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42
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Fayssal IA, Moukalled F, Alam S, Isma'eel H. An Outflow Boundary Condition Model for Noninvasive Prediction of Fractional Flow Reserve in Diseased Coronary Arteries. J Biomech Eng 2018; 140:2659642. [DOI: 10.1115/1.4038250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Indexed: 12/28/2022]
Abstract
This paper reports on a new boundary condition formulation to model the total coronary myocardial flow and resistance characteristics of the myocardial vascular bed for any specific patient when considered for noninvasive diagnosis of ischemia. The developed boundary condition model gives an implicit representation of the downstream truncated coronary bed. Further, it is based on incorporating patient-specific physiological parameters that can be noninvasively extracted to account for blood flow demand to the myocardium at rest and hyperemic conditions. The model is coupled to a steady three-dimensional (3D) collocated pressure-based finite volume flow solver and used to characterize the “functional significance” of a patient diseased coronary artery segment without the need for predicting the hemodynamics of the entire arterial system. Predictions generated with this boundary condition provide a deep understanding of the inherent challenges behind noninvasive image-based diagnostic techniques when applied to human diseased coronary arteries. The overall numerical method and formulated boundary condition model are validated via two computational-based procedures and benchmarked with available measured data. The newly developed boundary condition is used via a designed computational methodology to (a) confirm the need for incorporating patient-specific physiological parameters when modeling the downstream coronary resistance, (b) explain the discrepancies presented in the literature between measured and computed fractional flow reserve (FFRCT), and (c) discuss the current limitations and future challenges in shifting to noninvasive assessment of ischemia.
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Affiliation(s)
- Iyad A. Fayssal
- Computational Mechanics Laboratory, Mechanical Engineering Department, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Fadl Moukalled
- Professor Mechanical Engineering Department, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Samir Alam
- Professor Department of Internal Medicine, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
| | - Hussain Isma'eel
- Associate Professor Department of Internal Medicine, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail:
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43
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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: 140] [Impact Index Per Article: 20.0] [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
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44
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Pelletier-Galarneau M, Hunter CRRN, Ascah KJ, Beanlands RSB, Dwivedi G, deKemp RA, Chow BJW, Ruddy TD. Randomized Trial Comparing the Effects of Ticagrelor Versus Clopidogrel on Myocardial Perfusion in Patients With Coronary Artery Disease. J Am Heart Assoc 2017; 6:JAHA.117.005894. [PMID: 28465300 PMCID: PMC5524115 DOI: 10.1161/jaha.117.005894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ticagrelor is a P2Y12 receptor inhibitor used in acute coronary syndromes to reduce platelet activity and to decrease thrombus formation. Ticagrelor is associated with a reduction in mortality incremental to that observed with clopidogrel, potentially related to its non–antiplatelet effects. Evidence from animal models indicates that ticagrelor potentiates adenosine‐induced myocardial blood flow (MBF) increases. We investigated MBF at rest and during adenosine‐induced hyperemia in patients with stable coronary artery disease treated with ticagrelor versus clopidogrel. Methods and Results This randomized double‐blinded crossover study included 22 patients who received therapeutic interventions of ticagrelor 90 mg orally twice a day for 10 days and clopidogrel 75 mg orally once a day for 10 days, with a washout period of at least 10 days between the treatments. Global and regional MBF and myocardial flow reserve were measured using rubidium 82 positron emission tomography/computed tomography at baseline and during intermediate‐ and high‐dose adenosine. Global MBF was significantly greater with ticagrelor versus clopidogrel (1.28±0.55 versus 1.13±0.47 mL/min per gram, P=0.002) at intermediate‐dose adenosine and not different at baseline (0.65±0.19 versus 0.60±0.15 mL/min per gram, P=0.084) and at high‐dose adenosine (1.64±0.40 versus 1.61±0.19 mL/min per gram, P=0.53). In regions with impaired myocardial flow reserve (<2.5), MBF was greater with ticagrelor compared with clopidogrel during intermediate and high doses of adenosine (P<0.0001), whereas the differences were not significant at baseline. Conclusions Ticagrelor potentiates global and regional adenosine‐induced MBF increases in patients with stable coronary artery disease. This effect may contribute to the incremental mortality benefit compared with clopidogrel. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01894789.
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Affiliation(s)
- Matthieu Pelletier-Galarneau
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada.,Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Chad R R N Hunter
- Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kathryn J Ascah
- Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob S B Beanlands
- Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish Dwivedi
- Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert A deKemp
- Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Terrence D Ruddy
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada .,Department of Medicine, University of Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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45
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Chilra P, Gnesin S, Allenbach G, Monteiro M, Prior JO, Vieira L, Pires Jorge JA. Cardiac PET/CT with Rb-82: optimization of image acquisition and reconstruction parameters. EJNMMI Phys 2017; 4:10. [PMID: 28205113 PMCID: PMC5311016 DOI: 10.1186/s40658-017-0178-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/08/2017] [Indexed: 12/04/2022] Open
Abstract
Background Our aim was to characterize the influence of time-of-flight (TOF) and point spread function (PSF) recovery corrections, as well as ordered subset expectation maximization (OSEM) reconstruction parameters, in 82Rb PET/CT quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Rest and stress list-mode dynamic 82Rb PET acquisition data from 10 patients without myocardial flow defects and 10 patients with myocardial blood flow defects were reconstructed retrospectively. OSEM reconstructions were performed with Gaussian filters of 4, 6, and 8 mm, different iterations, and subset numbers (2 × 24; 2 × 16; 3 × 16; 4 × 16). Rest and stress global, regional, and segmental MBF and MFR were computed from time activity curves with FlowQuant© software. Left ventricular segmentation using the 17-segment American Heart Association model was obtained. Results Whole left ventricle (LV) MBF at rest and stress were 0.97 ± 0.30 and 2.30 ± 1.00 mL/min/g, respectively, and MFR was 2.40 ± 1.13. Concordance was excellent and all reconstruction parameters had no significant impact on MBF, except for the exclusion of TOF which led to significantly decreased concordance in rest and stress MBF in patients with or without perfusion defects on a coronary artery basis and in MFR in patients with perfusion defects. Conclusions Changes in reconstruction parameters in perfusion 82Rb PET/CT studies influence quantitative MBF analysis. The inclusion of TOF information in the tomographic reconstructions had significant impact in MBF quantification.
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Affiliation(s)
- P Chilra
- Haute École de Santé Vaud - Filière TRM, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland.,Área Científica de Medicina Nuclear, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - S Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland.,Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - G Allenbach
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - M Monteiro
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - J O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland
| | - L Vieira
- Área Científica de Medicina Nuclear, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal.,Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal
| | - J A Pires Jorge
- Haute École de Santé Vaud - Filière TRM, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
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Tosh AV, Reichek N, Cooke CD, Palestro CJ, Nichols KJ. Rb-82 PET/CT left ventricular mass-to-volume ratios. Int J Cardiovasc Imaging 2017; 33:1263-1270. [PMID: 28176182 DOI: 10.1007/s10554-017-1087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/28/2017] [Indexed: 10/20/2022]
Abstract
Left ventricular (LV) mass:volume ratios indexed to body size (Mi/Vi) provide risk stratification for cardiac events. We sought to determine whether Rb-82 PET mass and volume indices are similar to MRI normal values for low likelihood subjects, and whether abnormal indices are related to abnormal myocardial blood flow (MBF). Data were analyzed retrospectively for 194 patients referred for rest/stress Rb-82 PET. LV EF, volume and mass values were calculated and mass:volume ratios were indexed to patients' height and weight. MBF was computed from the first pass dynamic component of PET data. 53 patients at low likelihood of CAD had PET Mi/Vi = 1.35 ± 0.27, consistent with the MRI literature range of 1.0-1.5. Compared to patients with normal indexed volume (Vi), patients with abnormally high Vi had lower rest MBF (0.56 ± 0.24 vs 0.93 ± 0.57 ml/g/min, p = 0.0001), and lower stress MBF (0.97 ± 0.52 vs. 1.83 ± 0.96 ml/g/min, p < 0.0001). Stress EF < 50% predicted abnormal Vi with 90% accuracy. Patients with Mi/Vi < 1.0 had abnormally low rest EF (45 ± 16% vs. 60 ± 15%, p < 0.0001) and low rest MBF (0.58 ± 0.25 vs. 0.96 ± 0.59 ml/g/min, p < 0.0001). In our study population, abnormal LV volume and mass correlated with lower rest and stress MBF and EF, suggesting that the pathophysiologic explanation of these patients' increased risk is more extensive obstructive CAD.
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Affiliation(s)
- Andrew Van Tosh
- Department of Cardiovascular Research, St. Francis Hospital, Roslyn, NY, USA
| | - Nathaniel Reichek
- Department of Cardiovascular Research, St. Francis Hospital, Roslyn, NY, USA
| | - C David Cooke
- Department of Radiology, Emory University, Atlanta, GA, USA
| | - Christopher J Palestro
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Kenneth J Nichols
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.
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Michelsen MM, Mygind ND, Pena A, Olsen RH, Christensen TE, Ghotbi AA, Hasbak P, Kjaer A, Gustafsson I, Hansen PR, Hansen HS, Høst N, Kastrup J, Prescott E. Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary microvascular dysfunction: The iPOWER study. Int J Cardiol 2017; 228:435-443. [DOI: 10.1016/j.ijcard.2016.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
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Michelsen MM, Mygind ND, Frestad D, Prescott E. Women with Stable Angina Pectoris and No Obstructive Coronary Artery Disease: Closer to a Diagnosis. Eur Cardiol 2017; 12:14-19. [PMID: 30416544 DOI: 10.15420/ecr.2016:33:2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A large proportion of women with chest pain have no obstructive coronary artery disease. Recent studies have demonstrated that these women continue to have symptoms and are at increased risk of cardiovascular morbidity and mortality. Coronary microvascular dysfunction (CMD) leads to an impairment of blood flow regulation to the myocardium and possible transient ischaemia. CMD is a disease entity with several pathophysiologic aspects and diagnostic modalities continue to be developed. However, due to the complexity of the disease, it remains elusive whether CMD is the explanation for the symptoms and the poor prognosis in women with angina and no obstructive coronary artery disease.
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Affiliation(s)
- Marie Mide Michelsen
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen Copenhagen, Denmark
| | - Naja Dam Mygind
- Department of Cardiology, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Daria Frestad
- Department of Cardiology, Hvidovre Hospital, University of Copenhagen Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen Copenhagen, Denmark
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Chen C, Wei J, AlBadri A, Zarrini P, Bairey Merz CN. Coronary Microvascular Dysfunction - Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy. Circ J 2016; 81:3-11. [PMID: 27904032 PMCID: PMC8607842 DOI: 10.1253/circj.cj-16-1002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Angina has traditionally been thought to be caused by obstructive coronary artery disease (CAD). However, a substantial number of patients with angina are found to not have obstructive CAD when undergoing coronary angiography. A significant proportion of these patients have coronary microvascular dysfunction (CMD), characterized by heightened sensitivity to vasoconstrictor stimuli and limited microvascular vasodilator capacity. With the advent of non-invasive and invasive techniques, the coronary microvasculature has been more extensively studied in the past 2 decades. CMD has been identified as a cause of cardiac ischemia, in addition to traditional atherosclerotic disease and vasospastic disease. CMD can occur alone or in the presence obstructive CAD. CMD shares many similar risk factors with macrovascular CAD. Diagnosis is achieved through detection of an attenuated response of coronary blood flow in response to vasodilatory agents. Imaging modalities such as cardiovascular magnetic resonance, positron emission tomography, and transthoracic Doppler echocardiography have become more widely used, but have not yet completely replaced the traditional intracoronary vasoreactivity testing. Treatment of CMD starts with lifestyle modification and risk factor control. The use of traditional antianginal, antiatherosclerotic medications and some novel agents may be beneficial; however, clinical trials are needed to assess the efficacy of the pharmacologic and non-pharmacologic therapeutic modalities. In addition, studies with longer-term follow-up are needed to determine the prognostic benefits of these agents. We review the epidemiology, prognosis, pathogenesis, diagnosis, risk factors and current therapies for CMD.
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Affiliation(s)
- Cheng Chen
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
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50
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deKemp RA, Klein R, Beanlands RSB. (82)Rb PET imaging of myocardial blood flow-have we achieved the 4 "R"s to support routine use? EJNMMI Res 2016; 6:69. [PMID: 27650281 PMCID: PMC5030198 DOI: 10.1186/s13550-016-0225-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/02/2016] [Indexed: 01/29/2023] Open
Affiliation(s)
- Robert A deKemp
- Division of Cardiology, National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, Canada.
| | - Ran Klein
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Rob S B Beanlands
- Division of Cardiology, National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, Canada
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