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Renaud JM, Al-Mallah MH, Soman P, deKemp RA, Beanlands RSB, Arumugam P, Armstrong IS, Prior JO, Madamanchi C, Goonewardena S, Poitrasson-Rivière A, Moody JB, Ficaro EP, Murthy VL. How to differentiate obstructive from non-obstructive CAD: Developments in High-Resolution Regional Quantification of MBF and MFR. J Nucl Cardiol 2024:102023. [PMID: 39179097 DOI: 10.1016/j.nuclcard.2024.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024]
Affiliation(s)
| | | | - Prem Soman
- Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center
| | - Robert A deKemp
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa Ontario, Canada
| | - Rob S B Beanlands
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa Ontario, Canada
| | - Parthiban Arumugam
- Nuclear Medicine, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Ian S Armstrong
- Nuclear Medicine, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Chaitanya Madamanchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Sascha Goonewardena
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Ann Arbor Health System, Ann Arbor, MI
| | | | | | | | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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2
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Dahdal J, Jukema RA, Harms HJ, Cramer MJ, Raijmakers PG, Knaapen P, Danad I. PET myocardial perfusion imaging: Trends, challenges, and opportunities. J Nucl Cardiol 2024:102011. [PMID: 39067504 DOI: 10.1016/j.nuclcard.2024.102011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/25/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
Various non-invasive images are used in clinical practice for the diagnosis and prognostication of chronic coronary syndromes. Notably, quantitative myocardial perfusion imaging (MPI) through positron emission tomography (PET) has seen significant technical advancements and a substantial increase in its use over the past two decades. This progress has generated an unprecedented wealth of clinical information, which, when properly applied, can diagnose and fine-tune the management of patients with different types of ischemic syndromes. This state-of-art review focuses on quantitative PET MPI, its integration into clinical practice, and how it holds up at the eyes of modern cardiac imaging and revascularization clinical trials, along with future perspectives.
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Affiliation(s)
- Jorge Dahdal
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Hospital Del Salvador, Santiago, Chile
| | - Ruurt A Jukema
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter G Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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3
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Siekkinen R, Partanen H, Kukola L, Tolvanen T, Fenwick A, Smith NAS, Teräs M, Saraste A, Teuho J. Preliminary protocol for measuring the reproducibility and accuracy of flow values on digital PET/CT systems in [ 15O]H 2O myocardial perfusion imaging using a flow phantom. EJNMMI Phys 2024; 11:54. [PMID: 38951352 PMCID: PMC11217201 DOI: 10.1186/s40658-024-00654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/03/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Several factors may decrease the accuracy of quantitative PET myocardial perfusion imaging (MPI). It is therefore essential to ensure that myocardial blood flow (MBF) values are reproducible and accurate, and to design systematic protocols to achieve this. Until now, no systematic phantom protocols have been available to assess the technical factors affecting measurement accuracy and reproducibility in MPI. MATERIALS AND METHODS We implemented a standard measurement protocol, which applies a flow phantom in order to compare image-derived flow values with respect to a ground truth flow value with [15O]H2O MPI performed on both a Discovery MI (DMI-20, GE Healthcare) and a Biograph Vision 600 (Vision-600, Siemens Healthineers) system. Both systems have automatic [15O]H2O radio water generators (Hidex Oy) individually installed, allowing us to also study the differences occurring due to two different bolus delivery systems. To investigate the technical factors contributing to the modelled flow values, we extracted the [15O]H2O bolus profiles, the flow values from the kinetic modeling (Qin and Qout), and finally calculated their differences between test-retest measurements on both systems. RESULTS The measurements performed on the DMI-20 system produced Qin and Qout values corresponging to each other as well as to the reference flow value across all test-retest measurements. The repeatability differences on DMI-20 were 2.1% ± 2.6% and 3.3% ± 4.1% for Qin and Qout, respectively. On Vision-600 they were 10% ± 8.4% and 11% ± 10% for Qin and Qout, respectively. The measurements performed on the Vision-600 system showed more variation between Qin and Qout values across test-retest measurements and exceeded 15% difference in 7/24 of the measurements. CONCLUSIONS A preliminary protocol for measuring the accuracy and reproducibility of flow values in [15O]H2O MPI between digital PET/CT systems was assessed. The test-retest reproducibility falls below 15% in majority of the measurements conducted between two individual injector systems and two digital PET/CT systems. This study highlights the importance of implementing a standardized bolus injection and delivery protocol and importance of assessing technical factors affecting flow value reproducibility, which should be carefully investigated in a multi-center setting.
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Affiliation(s)
- Reetta Siekkinen
- Turku PET Centre, University of Turku, Turku, Finland.
- Turku PET Centre, Turku University Hospital and Wellbeing Services County of Southwest Finland, Turku, Finland.
- Department of Medical Physics, Turku University Hospital and Wellbeing Services County of Southwest Finland and University of Turku, Turku, Finland.
| | - Heidi Partanen
- Turku PET Centre, Turku University Hospital and Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Linda Kukola
- Turku PET Centre, Turku University Hospital and Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Physics and Astronomy, University of Turku, Turku, Finland
| | - Tuula Tolvanen
- Turku PET Centre, Turku University Hospital and Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Medical Physics, Turku University Hospital and Wellbeing Services County of Southwest Finland and University of Turku, Turku, Finland
| | | | | | - Mika Teräs
- Department of Medical Physics, Turku University Hospital and Wellbeing Services County of Southwest Finland and University of Turku, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and Wellbeing Services County of Southwest Finland, Turku, Finland
- Heart Centre, Turku University Hospital and Wellbeing Services County of Southwest Finland and University of Turku, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital and Wellbeing Services County of Southwest Finland, Turku, Finland
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4
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Moody JB, Poitrasson-Rivière A, Renaud JM, Hagio T, Al-Mallah MH, Weinberg RL, Ficaro EP, Murthy VL. Integrated myocardial flow reserve (iMFR) assessment: diffuse atherosclerosis and microvascular dysfunction are more strongly associated with mortality than focally impaired perfusion. Eur J Nucl Med Mol Imaging 2023; 51:123-135. [PMID: 37787848 DOI: 10.1007/s00259-023-06448-1] [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: 07/16/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND AIMS Although treatment of ischemia-causing epicardial stenoses may improve symptoms of ischemia, current evidence does not suggest that revascularization improves survival. Conventional myocardial ischemia imaging does not uniquely identify diffuse atherosclerosis, microvascular dysfunction, or nonobstructive epicardial stenoses. We sought to evaluate the prognostic value of integrated myocardial flow reserve (iMFR), a novel noninvasive approach to distinguish the perfusion impact of focal atherosclerosis from diffuse coronary disease. METHODS This study analyzed a large single-center registry of consecutive patients clinically referred for rest-stress myocardial perfusion positron emission tomography. Cox proportional hazards modeling was used to assess the association of two previously reported and two novel perfusion measures with mortality risk: global stress myocardial blood flow (MBF); global myocardial flow reserve (MFR); and two metrics derived from iMFR analysis: the extents of focal and diffusely impaired perfusion. RESULTS In total, 6867 patients were included with a median follow-up of 3.4 years [1st-3rd quartiles, 1.9-5.0] and 1444 deaths (21%). Although all evaluated perfusion measures were independently associated with death, diffusely impaired perfusion extent (hazard ratio 2.65, 95%C.I. [2.37-2.97]) and global MFR (HR 2.29, 95%C.I. [2.08-2.52]) were consistently stronger predictors than stress MBF (HR 1.62, 95%C.I. [1.46-1.79]). Focally impaired perfusion extent (HR 1.09, 95%C.I. [1.03-1.16]) was only moderately related to mortality. Diffusely impaired perfusion extent remained a significant independent predictor of death when combined with global MFR (p < 0.0001), providing improved risk stratification (overall net reclassification improvement 0.246, 95%C.I. [0.183-0.310]). CONCLUSIONS The extent of diffusely impaired perfusion is a strong independent and additive marker of mortality risk beyond traditional risk factors, standard perfusion imaging, and global MFR, while focally impaired perfusion is only moderately related to mortality.
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Affiliation(s)
| | | | | | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Richard L Weinberg
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edward P Ficaro
- INVIA, LLC, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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5
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Van Tosh A, Nichols KJ. SPECT measurements of myocardial blood flow and flow reserve: from development to implementation. J Nucl Cardiol 2023; 30:1437-1442. [PMID: 37160851 DOI: 10.1007/s12350-023-03273-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Andrew Van Tosh
- Research Department, St. Francis Hospital, 100 Port Washington Blvd., Roslyn, NY, 11576-1348, USA.
| | - Kenneth J Nichols
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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6
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Siekkinen R, Han C, Maaniitty T, Teräs M, Knuuti J, Saraste A, Teuho J. A retrospective evaluation of Bayesian-penalized likelihood reconstruction for [ 15O]H 2O myocardial perfusion imaging. J Nucl Cardiol 2023; 30:1602-1612. [PMID: 36656496 PMCID: PMC10371909 DOI: 10.1007/s12350-022-03164-5] [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: 02/22/2022] [Accepted: 11/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND New Block-Sequential-Regularized-Expectation-Maximization (BSREM) image reconstruction technique has been introduced for clinical use mainly for oncologic use. Accurate and quantitative image reconstruction is essential in myocardial perfusion imaging with positron emission tomography (PET) as it utilizes absolute quantitation of myocardial blood flow (MBF). The aim of the study was to evaluate BSREM reconstruction for quantitation in patients with suspected coronary artery disease (CAD). METHODS AND RESULTS We analyzed cardiac [15O]H2O PET studies of 177 patients evaluated for CAD. Differences between BSREM and Ordered-Subset-Expectation-Maximization with Time-Of-Flight (TOF) and Point-Spread-Function (PSF) modeling (OSEM-TOF-PSF) in terms of MBF, perfusable tissue fraction, and vascular volume fraction were measured. Classification of ischemia was assessed between the algorithms. OSEM-TOF-PSF and BSREM provided similar global stress MBF in patients with ischemia (1.84 ± 0.21 g⋅ml-1⋅min-1 vs 1.86 ± 0.21 g⋅ml-1⋅min-1) and no ischemia (3.26 ± 0.34 g⋅ml-1⋅min-1 vs 3.28 ± 0.34 g⋅ml-1⋅min-1). Global resting MBF was also similar (0.97 ± 0.12 g⋅ml-1⋅min-1 and 1.12 ± 0.06 g⋅ml-1⋅min-1). The largest mean relative difference in MBF values was 7%. Presence of myocardial ischemia was classified concordantly in 99% of patients using OSEM-TOF-PSF and BSREM reconstructions CONCLUSION: OSEM-TOF-PSF and BSREM image reconstructions produce similar MBF values and diagnosis of myocardial ischemia in patients undergoing [15O]H2O PET due to suspected obstructive coronary artery disease.
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Affiliation(s)
- Reetta Siekkinen
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Chunlei Han
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
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Van Tosh A, Cao JJ, Votaw JR, Cooke CD, Palestro CJ, Nichols KJ. Clinical implications of compromised 82Rb PET data acquisition. J Nucl Cardiol 2022; 29:2583-2594. [PMID: 34417670 DOI: 10.1007/s12350-021-02774-9] [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: 02/20/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We wished to document the prevalence and quantitative effects of compromised 82Rb PET data acquisitions on myocardial flow reserve (MFR). METHODS AND RESULTS Data were analyzed retrospectively for 246 rest and regadenoson-stress studies of 123 patients evaluated for known or suspected CAD. An automated injector delivered pre-determined activities of 82Rb. Automated quality assurance algorithms identified technical problems for 7% (9/123) of patients. Stress data exhibited 2 instances of scanner saturation, 1 blood peak detection, 1 blood peak width, 1 gradual patient motion, and 2 abrupt patient motion problems. Rest data showed 1 instance of blood peak width and 2 abrupt patient motion problems. MFR was lower for patients with technical problems flagged by the quality assurance algorithms than those without technical problems (1.5 ± 0.5 versus 2.1 ± 0.7, P = 0.01), even though rest and stress ejection fraction, asynchrony and relative myocardial perfusion measures were similar for these two groups (P > 0.05), suggesting that MFR accuracy was adversely affected by technical errors. CONCLUSION It is important to verify integrity of 82Rb data to ensure MFR computation quality.
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Affiliation(s)
- Andrew Van Tosh
- St. Francis Hospital, Roslyn, NY, USA
- Research Department, St. Francis Hospital, 100 Port Washington Blvd., Roslyn, NY, 11576-1348, USA
| | | | | | | | | | - Kenneth J Nichols
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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8
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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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Siekkinen R, Kirjavainen AK, Koskensalo K, Smith NAS, Fenwick A, Saunavaara V, Tolvanen T, Iida H, Saraste A, Teräs M, Teuho J. Assessment of a digital and an analog PET/CT system for accurate myocardial perfusion imaging with a flow phantom. J Nucl Cardiol 2022; 29:1964-1972. [PMID: 33948894 PMCID: PMC9345842 DOI: 10.1007/s12350-021-02631-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
In Myocardial Perfusion Imaging (MPI) with Positron Emission Tomography/Computed Tomography (PET/CT) systems, accurate quantification is essential. We assessed flow quantification accuracy over various injected activities using a flow phantom. METHODS The study was performed on the digital 4-ring Discovery MI (DMI-20) and analog Discovery 690 (D690) PET/CT systems, using 325-1257 MBq of [15O]H2O. PET performance and flow quantification accuracy were assessed in terms of count-rates, dead-time factors (DTF), scatter fractions (SF), time-activity curves (TACs), areas-under-the-curves (AUCs) and flow values. RESULTS On DMI-20, prompts of 12.8 Mcps, DTF of 2.06 and SF of 46.1% were measured with 1257 MBq of activity. On the D690, prompts of 6.85 Mcps, DTF of 1.57 and SF of 32.5% were measured with 1230 MBq of activity. AUC values were linear over all activities. Mean wash-in flow error was - 9% for both systems whereas wash-out flow error was - 5% and - 6% for DMI-20 and D690. With the highest activity, wash-out flow error was - 12% and - 7% for the DMI-20 and D690. CONCLUSION DMI-20 and D690 preserved accurate flow quantification over all injected activities, with maximum error of - 12%. In the future, flow quantification accuracy over the activities and count-rates evaluated in this study should be assessed.
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Affiliation(s)
- Reetta Siekkinen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20521, Finland.
- Department of Medical Physics, Turku University Hospital, Turku, Finland.
- Department of Computing, University of Turku, Turku, Finland.
| | - Anna K Kirjavainen
- Radiopharmaceutical Chemistry Laboratory, Turku PET Centre, University of Turku, Turku, Finland
| | - Kalle Koskensalo
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20521, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | | | | | - Virva Saunavaara
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20521, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuula Tolvanen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20521, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Hidehiro Iida
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20521, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20521, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Department of Biomedicine, University of Turku, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20521, Finland
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10
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Kamani CH, Prior J. Are we good enough in the evaluation of MPI using Rubidium82 with PMT PET/CT? A comparison to SiPM PET/CT. J Nucl Cardiol 2022; 29:213-215. [PMID: 32415629 DOI: 10.1007/s12350-020-02169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Christel H Kamani
- Department of Nuclear Medicine and Molecular Imaging, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - John Prior
- Department of Nuclear Medicine and Molecular Imaging, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
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11
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Marengo M, Martin CJ, Rubow S, Sera T, Amador Z, Torres L. Radiation Safety and Accidental Radiation Exposures in Nuclear Medicine. Semin Nucl Med 2021; 52:94-113. [PMID: 34916044 DOI: 10.1053/j.semnuclmed.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical radiation accidents and unintended events may lead to accidental or unintended medical exposure of patients and exposure of staff or the public. Most unintended exposures in nuclear medicine will lead to a small increase in risk; nevertheless, these require investigation and a clinical and dosimetric assessment. Nuclear medicine staff are exposed to radiation emitted directly by radiopharmaceuticals and by patients after administration of radiopharmaceuticals. This is particularly relevant in PET, due to the penetrating 511 keV γ-rays. Dose constraints should be set for planning the exposure of individuals. Staff body doses of 1-25 µSv/GBq are reported for PET imaging, the largest component being from the injection. The preparation and administration of radiopharmaceuticals can lead to high doses to the hands, challenging dose limits for radionuclides such as 90Y and even 18F. The risks of contamination can be minimized by basic precautions, such as carrying out manipulations in purpose-built facilities, wearing protective clothing, especially gloves, and removing contaminated gloves or any skin contamination as quickly as possible. Airborne contamination is a potential problem when handling radioisotopes of iodine or administering radioaerosols. Manipulating radiopharmaceuticals in laminar air flow cabinets, and appropriate premises ventilation are necessary to improve safety levels. Ensuring patient safety and minimizing the risk of incidents require efficient overall quality management. Critical aspects include: the booking process, particularly if qualified medical supervision is not present; administration of radiopharmaceuticals to patients, with the risk of misadministration or extravasation; management of patients' data and images by information technology systems, considering the possibility of misalignment between patient personal data and clinical information. Prevention of possible mistakes in patient identification or in the management of patients with similar names requires particular attention. Appropriate management of pregnant or breast-feeding patients is another important aspect of radiation safety. In radiopharmacy activities, strict quality assurance should be implemented at all operational levels, in addition to adherence to national and international regulations and guidelines. This includes not only administrative aspects, like checking the request/prescription, patient's data and the details of the requested procedure, but also quantitative tests according to national/international pharmacopoeias, and measuring the dispensed activity with a calibrated activity meter prior to administration. In therapy with radionuclides, skin tissue reactions can occur following extravasation, which can result in localized doses of tens of Grays. Other relevant incidents include confusion of products for patients administered at the same time or malfunction of administration devices. Furthermore, errors in internal radiation dosimetry calculations for treatment planning may lead to under or over-treatment. According to literature, proper instructions are fundamental to keep effective dose to caregivers and family members after patient discharge below the Dose constraints. The IAEA Basic Safety Standards require measures to minimize the likelihood of any unintended or accidental medical exposures and reporting any radiation incident. The relative complexity of nuclear medicine practice presents many possibilities for errors. It is therefore important that all activities are performed according to well established procedures, and that all actions are supported by regular quality assurance/QC procedures.
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Affiliation(s)
- Mario Marengo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
| | - Colin J Martin
- Department of Clinical Physics and Bioengineering, University of Glasgow, UK
| | - Sietske Rubow
- Nuclear Medicine Division, Stellenbosch University, Stellenbosch, South Africa
| | - Terez Sera
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Zayda Amador
- Radiation Protection Department, Centre of Isotopes, Havana, Cuba
| | - Leonel Torres
- Nuclear Medicine Department, Centre of Isotopes, Havana, Cuba
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12
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Poitrasson-Rivière A, Murthy VL. Optimizing accuracy and precision with motion correction of PET myocardial blood flow measurements. J Nucl Cardiol 2021; 28:1726-1729. [PMID: 31646472 DOI: 10.1007/s12350-019-01927-1] [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: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
Affiliation(s)
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
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13
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Armstrong IS, Memmott MJ, Saint KJ, Saillant A, Hayden C, Arumugam P. Assessment of motion correction in dynamic rubidium-82 cardiac PET with and without frame-by-frame adjustment of attenuation maps for calculation of myocardial blood flow. J Nucl Cardiol 2021; 28:1334-1346. [PMID: 31388967 DOI: 10.1007/s12350-019-01834-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/16/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patient motion during pharmacological stressing can have substantial impact on myocardial blood flow (MBF) estimated from dynamic PET. This work evaluated a motion correction algorithm with and without adjustment of the PET attenuation map. METHODS Frame-by-frame motion correction was performed by three users on 30 rubidium-82 studies. Data were divided equally into three groups of motion severity [mild (M1), moderate (M2) and severe (M3)]. MBF data were compared for non-motion corrected (NC), motion-corrected-only (MC) and with adjustment of the attenuation map (MCAC). Percentage differences of MBF were calculated in the coronary territories and 17-segment polar plots. Polar plots of spill-over were also generated from the data. RESULTS Median differences of 23% were seen in the RCA and 18% for the LAD in the M3 category for MC vs NC images. Differences for MCAC vs MC images were considerably smaller and typically < 10%. Spill-over plots for MC and MCAC were notably more uniform compared with NC images. CONCLUSION Motion correction for dynamic rubidium data is desirable for future MBF software updates. Adjustment of the PET attenuation map results in only marginal differences and therefore is unlikely to be an essential requirement. Assessing the uniformity of spill-over plots is a useful visual aid for verifying motion correction techniques.
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Affiliation(s)
- Ian S Armstrong
- Nuclear Medicine, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK.
| | - Matthew J Memmott
- Nuclear Medicine, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Kimberley J Saint
- Nuclear Medicine, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
| | - Antoine Saillant
- Siemens Medical Solutions USA, Inc, Molecular Imaging, Knoxville, TN, USA
| | - Charles Hayden
- Siemens Medical Solutions USA, Inc, Molecular Imaging, Knoxville, TN, USA
| | - Parthiban Arumugam
- Nuclear Medicine, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
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14
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Arida-Moody L, Moody JB, Renaud JM, Poitrasson-Rivière A, Hagio T, Smith AM, Ficaro EP, Murthy VL. Effects of two patient-specific dosing protocols on measurement of myocardial blood flow with 3D 82Rb cardiac PET. Eur J Nucl Med Mol Imaging 2021; 48:3835-3846. [PMID: 33982174 DOI: 10.1007/s00259-021-05385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Clinical measurement of myocardial blood flow (MBF) has emerged as an important component of routine PET-CT assessment of myocardial perfusion in patients with known or suspected coronary artery disease. Although multiple society guidelines recommend patient-specific dosing, there is a lack of studies evaluating the efficacy of patient-specific dosing for quantitative MBF accuracy. METHODS Two patient-specific dosing protocols (weight- and BMI-adjusted) were retrospectively evaluated in 435 consecutive clinical patients referred for PET myocardial perfusion assessment. MBF was estimated at rest and after regadenoson-induced hyperemia. The effect of dosing protocol on dose reduction, PET scanner saturation, relative perfusion, and image quality was compared. The effect of PET saturation on the accuracy of MBF and myocardial flow reserve (MFR) in remote myocardium was assessed with multivariable linear regression. RESULTS BMI-adjusted dosing was associated with lower administered 82Rb activities (1036.0 ± 274 vs. 1147 ± 274 MBq, p = 0.003) and lower PET scanner saturation incidence (28 vs. 38%, p = 0.006) and severity (median saturation severity index 0.219 ± 0.33 vs. 0.397 ± 0.59%, p = 0.018) compared to weight-adjusted dosing. PET saturation that occurred with either dosing protocol was moderate and resulted in modest remote MBF and MFR biases ranging from 2 to 9% after adjusting for patient age, sex, BMI, rate-pressure product, and LV ejection fraction. No adverse effects of BMI dose adjustment were observed in relative perfusion assessment or image quality. CONCLUSIONS Patient-specific dosing according to BMI is an effective method for guideline-directed dose reduction while maintaining image quality and accuracy for routine MBF and MFR quantification.
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Affiliation(s)
- Liliana Arida-Moody
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | | | - Edward P Ficaro
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- INVIA, LLC, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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15
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Slomka PJ, Moody JB, Miller RJH, Renaud JM, Ficaro EP, Garcia EV. Quantitative clinical nuclear cardiology, part 2: Evolving/emerging applications. J Nucl Cardiol 2021; 28:115-127. [PMID: 33067750 DOI: 10.1007/s12350-020-02337-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
Quantitative analysis has been applied extensively to image processing and interpretation in nuclear cardiology to improve disease diagnosis and risk stratification. This is Part 2 of a two-part continuing medical education article, which will review the potential clinical role for emerging quantitative analysis tools. The article will describe advanced methods for quantifying dyssynchrony, ventricular function and perfusion, and hybrid imaging analysis. This article discusses evolving methods to measure myocardial blood flow with positron emission tomography and single-photon emission computed tomography. Novel quantitative assessments of myocardial viability, microcalcification and in patients with cardiac sarcoidosis and cardiac amyloidosis will also be described. Lastly, we will review the potential role for artificial intelligence to improve image analysis, disease diagnosis, and risk prediction. The potential clinical role for all these novel techniques will be highlighted as well as methods to optimize their implementation.
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Affiliation(s)
- Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | | | - Robert J H Miller
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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16
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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: 72] [Impact Index Per Article: 18.0] [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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17
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Letter to the editor: Lassen et al. 3D PET/CT 82Rb PET myocardial blood flow quantification: comparison of half-dose and full-dose protocols. Eur J Nucl Med Mol Imaging 2020; 47:2729-2730. [DOI: 10.1007/s00259-020-04950-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
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18
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Slomka PJ, Moody JB, Miller RJH, Renaud JM, Ficaro EP, Garcia EV. Quantitative clinical nuclear cardiology, part 2: Evolving/emerging applications. J Nucl Med 2020; 62:168-176. [PMID: 33067339 DOI: 10.2967/jnumed.120.242537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 01/15/2023] Open
Abstract
Quantitative analysis has been applied extensively to image processing and interpretation in nuclear cardiology to improve disease diagnosis and risk stratification. This is Part 2 of a two-part continuing medical education article, which will review the potential clinical role for emerging quantitative analysis tools. The article will describe advanced methods for quantifying dyssynchrony, ventricular function and perfusion, and hybrid imaging analysis. This article discusses evolving methods to measure myocardial blood flow with positron emission tomography and single-photon emission computed tomography. Novel quantitative assessments of myocardial viability, microcalcification and in patients with cardiac sarcoidosis and cardiac amyloidosis will also be described. Lastly, we will review the potential role for artificial intelligence to improve image analysis, disease diagnosis, and risk prediction. The potential clinical role for all these novel techniques will be highlighted as well as methods to optimize their implementation. (J Nucl Cardiol 2020).
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Affiliation(s)
- Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Robert J H Miller
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI.,Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
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19
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Zuo Y, Badawi RD, Foster CC, Smith T, López JE, Wang G. Multiparametric Cardiac 18F-FDG PET in Humans: Kinetic Model Selection and Identifiability Analysis. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2020; 4:759-767. [PMID: 33778234 DOI: 10.1109/trpms.2020.3031274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac 18F-FDG PET has been used in clinics to assess myocardial glucose metabolism. Its ability for imaging myocardial glucose transport, however, has rarely been exploited in clinics. Using the dynamic FDG-PET scans of ten patients with coronary artery disease, we investigate in this paper appropriate dynamic scan and kinetic modeling protocols for efficient quantification of myocardial glucose transport. Three kinetic models and the effect of scan duration were evaluated by using statistical fit quality, assessing the impact on kinetic quantification, and analyzing the practical identifiability. The results show that the kinetic model selection depends on the scan duration. The reversible two-tissue model was needed for a one-hour dynamic scan. The irreversible two-tissue model was optimal for a scan duration of around 10-15 minutes. If the scan duration was shortened to 2-3 minutes, a one-tissue model was the most appropriate. For global quantification of myocardial glucose transport, we demonstrated that an early dynamic scan with a duration of 10-15 minutes and irreversible kinetic modeling was comparable to the full one-hour scan with reversible kinetic modeling. Myocardial glucose transport quantification provides an additional physiological parameter on top of the existing assessment of glucose metabolism and has the potential to enable single tracer multiparametric imaging in the myocardium.
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Affiliation(s)
- Yang Zuo
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA 9817
| | - Ramsey D Badawi
- Department of Radiology and Department of Biomedical Engineering, University of California Davis Medical Center, Sacramento, CA 9817
| | - Cameron C Foster
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA 9817
| | - Thomas Smith
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA 9817
| | - Javier E López
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA 9817
| | - Guobao Wang
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA 9817
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20
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Armstrong IS, Memmott MJ. A tale of two phases: Can the worst of scans become the best of scans with motion correction? J Nucl Cardiol 2019; 26:1930-1933. [PMID: 29777483 DOI: 10.1007/s12350-018-1305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Ian S Armstrong
- Nuclear Medicine Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK.
| | - Matthew J Memmott
- Nuclear Medicine Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, UK
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21
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Rimoldi O. Striving to improve 82Rubidium PET MPI accuracy. J Nucl Cardiol 2019; 26:1943-1945. [PMID: 30136035 DOI: 10.1007/s12350-018-1419-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Ornella Rimoldi
- IBFM Consiglio Nazionale delle Ricerche Segrate, Via Fratelli Cervi, 93, 20090, Segrate, Italy.
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22
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von Felten E, Giannopoulos AA. Myocardial Creep: we can now look it in the eye without framewise PET-CT registration for myocardial blood flow quantification. J Nucl Cardiol 2019; 26:747-748. [PMID: 30919270 DOI: 10.1007/s12350-019-01695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Elia von Felten
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Cardiology Department, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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23
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Pelletier-Galarneau M, Ruddy TD. The potential for PET-guided revascularization of coronary artery disease. Eur J Nucl Med Mol Imaging 2019; 46:1218-1221. [DOI: 10.1007/s00259-019-04316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
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24
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Koenders SS, van Dijk JD, Jager PL, Ottervanger JP, Slump CH, van Dalen JA. How to detect and correct myocardial creep in myocardial perfusion imaging using Rubidium-82 PET? J Nucl Cardiol 2019; 26:729-734. [PMID: 30788759 PMCID: PMC6517341 DOI: 10.1007/s12350-019-01650-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/24/2022]
Abstract
Reliability of myocardial blood flow (MBF) quantification in myocardial perfusion imaging (MPI) using PET can majorly be affected by the occurrence of myocardial creep when using pharmacologically induced stress. In this paper, we provide instructions on how to detect and correct for myocardial creep. For example, in each time frame of the PET images the myocardium contour and the observed activity have to be compared to check for misalignments. In addition, we provide an overview of the functionality of commonly used software packages to perform this quality control step as not all software packages currently provide this functionality. Furthermore, important clinical considerations to obtain accurate MBF measurements are given.
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Affiliation(s)
- S S Koenders
- Department of Nuclear Medicine, Isala hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- MIRA: Institute for Biomedical Technology and Technical Medicine, 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
| | - J P Ottervanger
- Department of Cardiology, Isala hospital, Zwolle, The Netherlands
| | - C H Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala hospital, Zwolle, The Netherlands
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25
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Saillant A, Armstrong I, Shah V, Zuehlsdorff S, Hayden C, Declerck J, Saint K, Memmott M, Jenkinson M, Chappell MA. Assessing Reliability of Myocardial Blood Flow After Motion Correction With Dynamic PET Using a Bayesian Framework. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:1216-1226. [PMID: 30452353 DOI: 10.1109/tmi.2018.2881992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The estimation of myocardial blood flow (MBF) in dynamic PET can be biased by many different processes. A major source of error, particularly in clinical applications, is patient motion. Patient motion, or gross motion, creates displacements between different PET frames as well as between the PET frames and the CT-derived attenuation map, leading to errors in MBF calculation from voxel time series. Motion correction techniques are challenging to evaluate quantitatively and the impact on MBF reliability is not fully understood. Most metrics, such as signal-to-noise ratio (SNR), are characteristic of static images, and are not specific to motion correction in dynamic data. This study presents a new approach of estimating motion correction quality in dynamic cardiac PET imaging. It relies on calculating a MBF surrogate, K1 , along with the uncertainty on the parameter. This technique exploits a Bayesian framework, representing the kinetic parameters as a probability distribution, from which the uncertainty measures can be extracted. If the uncertainty extracted is high, the parameter studied is considered to have high variability - or low confidence - and vice versa. The robustness of the framework is evaluated on simulated time activity curves to ensure that the uncertainties are consistently estimated at the multiple levels of noise. Our framework is applied on 40 patient datasets, divided in 4 motion magnitude categories. Experienced observers manually realigned clinical datasets with 3D translations to correct for motion. K1 uncertainties were compared before and after correction. A reduction of uncertainty after motion correction of up to 60% demonstrates the benefit of motion correction in dynamic PET and as well as provides evidence of the usefulness of the new method presented.
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26
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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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27
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Lee JS, Kovalski G, Sharir T, Lee DS. Advances in imaging instrumentation for nuclear cardiology. J Nucl Cardiol 2019; 26:543-556. [PMID: 28718074 DOI: 10.1007/s12350-017-0979-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/08/2017] [Indexed: 12/22/2022]
Abstract
Advances in imaging instrumentation and technology have greatly contributed to nuclear cardiology. Dedicated cardiac SPECT cameras incorporating novel, highly efficient detector, collimator, and system designs have emerged with the expansion of nuclear cardiology. Solid-state radiation detectors incorporating cadmium zinc telluride, which directly convert radiation to electrical signals and yield improved energy resolution and spatial resolution and enhanced count sensitivity geometries, are increasingly gaining favor as the detector of choice for application in dedicated cardiac SPECT systems. Additionally, hybrid imaging systems in which SPECT and PET are combined with X-ray CT are currently widely used, with PET/MRI hybrid systems having also been recently introduced. The improved quantitative SPECT/CT has the potential to measure the absolute quantification of myocardial blood flow and flow reserve. Rapid development of silicon photomultipliers leads to enhancement in PET image quality and count rates. In addition, the reduction of emission-transmission mismatch artifacts via application of accurate time-of-flight information, and cardiac motion de-blurring aided by anatomical images, are emerging techniques for further improvement of cardiac PET. This article reviews recent advances such as these in nuclear cardiology imaging instrumentation and technology, and the corresponding diagnostic benefits.
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Affiliation(s)
- Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | | | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea.
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Korea.
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28
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Feasibility of dynamic stress 201Tl/rest 99mTc-tetrofosmin single photon emission computed tomography for quantification of myocardial perfusion reserve in patients with stable coronary artery disease. Eur J Nucl Med Mol Imaging 2018; 45:2173-2180. [DOI: 10.1007/s00259-018-4057-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
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29
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Saraste A, Ukkonen H, Knuuti J. Protection of coronary circulation: Evaluation by PET perfusion imaging. J Nucl Cardiol 2018; 25:897-899. [PMID: 28050860 DOI: 10.1007/s12350-016-0765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
- Heart Center, Turku University Hospital, Hämeentie 11, 20520, Turku, Finland.
| | - Heikki Ukkonen
- Heart Center, Turku University Hospital, Hämeentie 11, 20520, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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30
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Case J. Accurate myocardial blood flow measurements: Quality from start to finish is key to success. J Nucl Cardiol 2018; 25:942-946. [PMID: 27914006 DOI: 10.1007/s12350-016-0690-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 12/24/2022]
Abstract
Overall repeatability and accuracy of myocardial blood flow measurements depend on the quality of the image data, the proper use of the quantitative software, and the training of clinical staff. Unlike most imaging tests, absolute blood flow measurements have the potential to provide accurate information beyond what is seen visually. This additive information has been shown to help identify multivessel disease, balanced ischemia, true normal studies, and quality control problems that may not be visible in the relative perfusion pattern. Absolute blood flow and flow reserve measurements have been shown to be useful and reproducible on a wide array of imaging systems, radiotracer delivery systems, and software approaches. Regardless of the technology or technique, these benefits can only be achieved when the quality of the study is sufficient and the clinical staff is properly trained on its implementation.
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Affiliation(s)
- James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA.
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31
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Moncayo VM, Garcia EV. Prompt-gamma compensation in Rb-82 myocardial perfusion 3D PET/CT: Effect on clinical practice. J Nucl Cardiol 2018; 25:606-608. [PMID: 27659456 DOI: 10.1007/s12350-016-0672-3] [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: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Valeria M Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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32
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Votaw JR, Packard RRS. Technical aspects of acquiring and measuring myocardial blood flow: Method, technique, and QA. J Nucl Cardiol 2018; 25:665-670. [PMID: 28864981 PMCID: PMC6443413 DOI: 10.1007/s12350-017-1049-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/16/2017] [Indexed: 01/07/2023]
Abstract
Measuring absolute myocardial blood flow (MBF) is becoming a common aid for diagnosing patients suspected to have coronary artery disease. An MBF study, however, requires a scanner with high count rate capability, is more susceptible to artifacts, and is much more technically involved than static imaging, which leads to a greater risk of artifactual results contaminating the final result. This technical note gives the reader an introductory understanding of the method for calculating MBF. It then describes the scanning protocol, potential pitfalls and how to recognize them, and quality control steps that should be taken to avoid basing a clinical decision on possibly inaccurate flow information.
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Affiliation(s)
- John R Votaw
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
| | - René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, California, USA
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33
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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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34
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Armstrong IS, Memmott MJ, Tonge CM, Arumugam P. The impact of prompt gamma compensation on myocardial blood flow measurements with rubidium-82 dynamic PET. J Nucl Cardiol 2018; 25:596-605. [PMID: 27624818 DOI: 10.1007/s12350-016-0583-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rubidium-82 myocardial perfusion imaging is a well-established technique for assessing myocardial ischemia. With continuing interest on myocardial blood flow (MBF) and myocardial flow reserve (MFR) measurements, there is a requirement to fully appreciate the impact of technical aspects of the process. One such factor for rubidium-82 is prompt gamma compensation (PGC). This study aims to assess the impact of PGC on MBF and MFR calculated from dynamic Rb-82 data. METHODS Dynamic rest and stress images were acquired on a Siemens Biograph mCT and reconstructed with and without PGC in 50 patients (29 male). MBF and MFR were measured in the three main coronary territories as well as globally. RESULTS With PGC, statistically significant reductions in MBF were observed in LAD (-6.9%), LCx (-4.8%), and globally (-6.5%) but only in obese patients. Significant increases in MBF were observed in RCA (+6.4%) in only nonobese patients. In very obese patients, differences of up to 40% in MBF were observed between PGC and non-PGC images. In nearly all cases, similar PGC differences were observed at stress and rest so there were no significant differences in MFR; however, in a small number of very obese patients, differences in excess of 20% were observed. CONCLUSION PGC results in statistically significant changes in MBF, with the greatest reductions observed in the LAD and LCx territories of obese patients. In most cases, the impact on stress and rest data is of similar relative magnitudes and changes to MFR are small.
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Affiliation(s)
- Ian S Armstrong
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, United Kingdom.
| | - 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
| | - Parthiban Arumugam
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, United Kingdom
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Piccinelli M, Votaw JR, Garcia EV. Motion Correction and Its Impact on Absolute Myocardial Blood Flow Measures with PET. Curr Cardiol Rep 2018; 20:34. [PMID: 29574494 DOI: 10.1007/s11886-018-0977-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Motion artifacts, due to cardiac and respiratory cycles, myocardial cardiac creep, or gross patient movements, have been extensively investigated in the context of relative myocardial perfusion imaging with SPECT and PET. These movements have been identified as a major source of errors in image quantification and diagnosis. Recently, as dynamic PET quantification for myocardial blood flow assessment has entered clinical practice, similar questions have arisen on the impact of motion on final blood flow values. RECENT FINDINGS While preliminary investigations have underlined the potential impact of these motions on MBF quantification, their correction on dynamic acquisition remains challenging and limited to research studies. Gross patient's body movements occur in a consistent number of cases, particularly during stress acquisition, typically involving a limited number of image frames. If undetected, these movements can lead to great differences in flow values and consequently misdiagnosis. Quality control routines can be applied to automatically inspect the shape of time activity curves and to help identify motion artifacts. Cyclic cardiac and respiratory motion may have a considerable impact on final flow values. Correction of gross body motion represents a priority in the context of optimizing absolute flow clinical routine utilization and protocol standardization.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1203-C, 101 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - John R Votaw
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1203-C, 101 Woodruff Circle, Atlanta, GA, 30322, USA.,, Alpharetta, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1203-C, 101 Woodruff Circle, Atlanta, GA, 30322, USA
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Comparison among Reconstruction Algorithms for Quantitative Analysis of 11C-Acetate Cardiac PET Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:9193403. [PMID: 29681784 PMCID: PMC5851317 DOI: 10.1155/2018/9193403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/12/2017] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
Abstract
Objective Kinetic modeling of dynamic 11C-acetate PET imaging provides quantitative information for myocardium assessment. The quality and quantitation of PET images are known to be dependent on PET reconstruction methods. This study aims to investigate the impacts of reconstruction algorithms on the quantitative analysis of dynamic 11C-acetate cardiac PET imaging. Methods Suspected alcoholic cardiomyopathy patients (N = 24) underwent 11C-acetate dynamic PET imaging after low dose CT scan. PET images were reconstructed using four algorithms: filtered backprojection (FBP), ordered subsets expectation maximization (OSEM), OSEM with time-of-flight (TOF), and OSEM with both time-of-flight and point-spread-function (TPSF). Standardized uptake values (SUVs) at different time points were compared among images reconstructed using the four algorithms. Time-activity curves (TACs) in myocardium and blood pools of ventricles were generated from the dynamic image series. Kinetic parameters K1 and k2 were derived using a 1-tissue-compartment model for kinetic modeling of cardiac flow from 11C-acetate PET images. Results Significant image quality improvement was found in the images reconstructed using iterative OSEM-type algorithms (OSME, TOF, and TPSF) compared with FBP. However, no statistical differences in SUVs were observed among the four reconstruction methods at the selected time points. Kinetic parameters K1 and k2 also exhibited no statistical difference among the four reconstruction algorithms in terms of mean value and standard deviation. However, for the correlation analysis, OSEM reconstruction presented relatively higher residual in correlation with FBP reconstruction compared with TOF and TPSF reconstruction, and TOF and TPSF reconstruction were highly correlated with each other. Conclusion All the tested reconstruction algorithms performed similarly for quantitative analysis of 11C-acetate cardiac PET imaging. TOF and TPSF yielded highly consistent kinetic parameter results with superior image quality compared with FBP. OSEM was relatively less reliable. Both TOF and TPSF were recommended for cardiac 11C-acetate kinetic analysis.
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37
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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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38
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Saraste A, Knuuti J. SPECT but not PET remains as the working horse of the state of the art nuclear cardiac imaging laboratory: Con. J Nucl Cardiol 2018; 25:198-202. [PMID: 28762094 DOI: 10.1007/s12350-017-1003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Antti Saraste
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
- Heart Center, Turku University Hospital, Hämeentie 11, 20520, Turku, Finland.
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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39
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王 沛, 路 利, 曹 双, 李 华, 陈 武. [Kinetic cluster and α-divergence-based dynamic myocardial factorial analysis of positron-emission computed tomography images]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1577-1584. [PMID: 29292248 PMCID: PMC6744016 DOI: 10.3969/j.issn.1673-4254.2017.12.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We purpose a novel factor analysis method based on kinetic cluster and α-divergence measure for extracting the blood input function and the time-activity curve of the regional tissue from dynamic myocardial positron emission computed tomography(PET) images. METHODS Dynamic PET images were decomposed into initial factors and factor images by minimizing the α-divergence between the factor model and actual image data. The kinetic clustering as a priori constraint was then incorporated into the model to solve the nonuniqueness problem, and the tissue time-activity curves and the tissue space distributions with physiological significance were generated. RESULTS The model was applied to the 82RbPET myocardial perfusion simulation data and compared with the traditional model-based least squares measure and the minimal spatial overlap constraint. The experimental results showed that the proposed model performed better than the traditional model in terms of both accuracy and sensitivity. CONCLUSION This method can select the optimal measure by α value, and incorporate the prior information of the kinetic clustering of PET image pixels to obtain the accurate time-activity curves of the tissue, which has shown good performance in visual evaluation and quantitative evaluation.
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Affiliation(s)
- 沛沛 王
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室,广东 广州 510515Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - 利军 路
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室,广东 广州 510515Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - 双亮 曹
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室,广东 广州 510515Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - 华勇 李
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室,广东 广州 510515Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - 武凡 陈
- />南方医科大学生物医学工程学院//广东省医学图像处理重点实验室,广东 广州 510515Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
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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. 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: 147] [Impact Index Per Article: 21.0] [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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O' Doherty J, Chalampalakis Z, Schleyer P, Nazir MS, Chiribiri A, Marsden PK. The effect of high count rates on cardiac perfusion quantification in a simultaneous PET-MR system using a cardiac perfusion phantom. EJNMMI Phys 2017; 4:31. [PMID: 29230607 PMCID: PMC5725400 DOI: 10.1186/s40658-017-0199-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PET-MRI is under investigation as a new strategy for quantitative myocardial perfusion imaging. Consideration is required as to the maximum scanner count rate in order to limit dead-time losses resulting from administered activity in the scanner field of view during the first pass of the radiotracer. RESULTS We performed a decaying-source experiment to investigate the high count-rate performance of a PET-MR system (Siemens mMR) over the expected range of activities during a clinical study. We also performed imaging of a cardiac perfusion phantom, which provides an experimental simulation of clinical transit of a simultaneous radiotracer (phantom injected activities range 252 to 997 MBq) and gadolinium-based contrast agent (GBCA). Time-activity and time-intensity curves of the aorta and myocardium compartments from PET and MR images were determined, and quantification of perfusion was then performed using a standard cardiac kinetic model. The decaying-source experiment showed a maximum noise equivalent count rate (NECRmax) of 286 kcps at a singles rate of 47.1 Mcps. NECR was maintained within 5% (NECR95%) of the NECRmax with a singles rate of 34.1 Mcps, corresponding to 310 MBq in the phantom. Count-rate performance was degraded above the singles rate of 64.9 Mcps due to the number of detection events impacting the quantitative accuracy of reconstructed images. A 10% bias in image activity concentration was observed between singles rates of 78.2 and 82.9 Mcps. Perfusion phantom experiments showed that image-based activity concentration and quantified values of perfusion were affected by count losses when the total singles rate was greater than 64.9 Mcps. This occurred during the peak arterial input function (AIF) phase of imaging for injected activities to the phantom of 600 MBq and greater. CONCLUSIONS Care should be taken to avoid high count-rate losses in simultaneous PET-MRI studies. Based on our results in phantoms, bias in reconstructed images should be avoided by adhering to a singles rate lower than 64.9 Mcps on the mMR system. Quantification of perfusion values using singles rates higher than 64.9 Mcps on this system may be compromised and should be avoided.
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Affiliation(s)
- Jim O' Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK.
- Department of Molecular Imaging, Sidra Medical and Research Center, Al Luqta St, Doha, Qatar.
| | - Zacharias Chalampalakis
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK
| | | | - Muhummad Sohaib Nazir
- BHF Centre of Excellence, NIHR Biomedical Research Centre and Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amedeo Chiribiri
- BHF Centre of Excellence, NIHR Biomedical Research Centre and Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul K Marsden
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK
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42
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Klein R, Ocneanu A, deKemp RA. Time-frame sampling for 82Rb PET flow quantification: Towards standardization of clinical protocols. J Nucl Cardiol 2017; 24:1530-1534. [PMID: 28687966 DOI: 10.1007/s12350-017-0981-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Ran Klein
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Nuclear Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Adrian Ocneanu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
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43
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Lee BC, Moody JB, Weinberg RL, Corbett JR, Ficaro EP, Murthy VL. Optimization of temporal sampling for 82rubidium PET myocardial blood flow quantification. J Nucl Cardiol 2017; 24:1517-1529. [PMID: 28508271 PMCID: PMC5685939 DOI: 10.1007/s12350-017-0899-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Suboptimal temporal sampling of left ventricular (LV) blood pool and tissue time-activity curves (TACs) may introduce bias and increased variability in estimates of myocardial blood flow (MBF) and flow reserve (MFR) from dynamic PET myocardial perfusion images. We aimed to optimize temporal sampling for estimation of MBF and MFR. METHODS Twenty-four normal volunteers and 32 patients underwent dynamic stress/rest rubidium-82 chloride (82Rb) PET imaging. Fine temporal sampling was used to estimate the full width at half maximum (FWHM) of the LV blood pool TAC. Fourier analysis was used to determine the longest sampling interval, T S, as a function of FWHM, which preserved the information content of the blood phase. Dynamic datasets were reconstructed with frame durations varying from 2 to 20 seconds over the first 2 minutes for the blood phase and 30 to 120 seconds for the tissue phase. The LV blood pool and tissue TACs were sampled using regions of interest (ROI) and fit to a compartment model for quantification of MBF and MFR. The effects of temporal sampling on MBF and MFR were evaluated using clinical data and simulations. RESULTS T S increased linearly with input function FWHM (R = 0.93). Increasing the blood phase frame duration from 5 to 15 seconds resulted in MBF and MFR biases of 6-12% and increased variability of 14-24%. Frame durations <5 seconds had biases of less than 5% for both MBF and MFR values. Increasing the tissue phase frame durations from 30 to 120 seconds resulted in <5% biases. CONCLUSIONS A two-phase framing of dynamic 82Rb PET images with frame durations of 5 seconds (blood phase) and 120 seconds (tissue phase) optimally samples the blood pool TAC for modern 3D PET systems.
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Affiliation(s)
| | | | - Richard L. Weinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - James R. Corbett
- INVIA Medical Imaging Solutions, Ann Arbor, MI
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Edward P. Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Venkatesh L. Murthy
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
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Lassen ML, Muzik O, Beyer T, Hacker M, Ladefoged CN, Cal-González J, Wadsak W, Rausch I, Langer O, Bauer M. Reproducibility of Quantitative Brain Imaging Using a PET-Only and a Combined PET/MR System. Front Neurosci 2017; 11:396. [PMID: 28769742 PMCID: PMC5511842 DOI: 10.3389/fnins.2017.00396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/23/2017] [Indexed: 01/02/2023] Open
Abstract
The purpose of this study was to test the feasibility of migrating a quantitative brain imaging protocol from a positron emission tomography (PET)-only system to an integrated PET/MR system. Potential differences in both absolute radiotracer concentration as well as in the derived kinetic parameters as a function of PET system choice have been investigated. Five healthy volunteers underwent dynamic (R)-[11C]verapamil imaging on the same day using a GE-Advance (PET-only) and a Siemens Biograph mMR system (PET/MR). PET-emission data were reconstructed using a transmission-based attenuation correction (AC) map (PET-only), whereas a standard MR-DIXON as well as a low-dose CT AC map was applied to PET/MR emission data. Kinetic modeling based on arterial blood sampling was performed using a 1-tissue-2-rate constant compartment model, yielding kinetic parameters (K1 and k2) and distribution volume (V T ). Differences for parametric values obtained in the PET-only and the PET/MR systems were analyzed using a 2-way Analysis of Variance (ANOVA). Comparison of DIXON-based AC (PET/MR) with emission data derived from the PET-only system revealed average inter-system differences of -33 ± 14% (p < 0.05) for the K1 parameter and -19 ± 9% (p < 0.05) for k2. Using a CT-based AC for PET/MR resulted in slightly lower systematic differences of -16 ± 18% for K1 and -9 ± 10% for k2. The average differences in V T were -18 ± 10% (p < 0.05) for DIXON- and -8 ± 13% for CT-based AC. Significant systematic differences were observed for kinetic parameters derived from emission data obtained from PET/MR and PET-only imaging due to different standard AC methods employed. Therefore, a transfer of imaging protocols from PET-only to PET/MR systems is not straightforward without application of proper correction methods. Clinical Trial Registration: www.clinicaltrialsregister.eu, identifier 2013-001724-19.
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Affiliation(s)
- Martin L Lassen
- Center for Medical Physics and Biomedical Engineering, Medical University of ViennaVienna, Austria
| | - Otto Muzik
- Department of Radiology, Detroit Medical Center, Children's Hospital of Michigan, Wayne State University School of MedicineDetroit, MI, United States
| | - Thomas Beyer
- Center for Medical Physics and Biomedical Engineering, Medical University of ViennaVienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of ViennaVienna, Austria
| | - Claes Nøhr Ladefoged
- Department of Clinical Physiology, Nuclear Medicine and PETRigshospitalet, Copenhagen, Denmark
| | - Jacobo Cal-González
- Center for Medical Physics and Biomedical Engineering, Medical University of ViennaVienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of ViennaVienna, Austria.,CBmed GmbH, Center for Biomarker Research in MedicineGraz, Austria
| | - Ivo Rausch
- Center for Medical Physics and Biomedical Engineering, Medical University of ViennaVienna, Austria
| | - Oliver Langer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of ViennaVienna, Austria.,Department for Clinical Pharmacology, Medical University of ViennaVienna, Austria.,Health and Environment Department, AIT Austrian Institute of Technology GmbHSeibersdorf, Austria
| | - Martin Bauer
- Department for Clinical Pharmacology, Medical University of ViennaVienna, Austria
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AlJaroudi WA, Lloyd SG, Chaudhry FA, Hage FG. Multi-modality imaging: Bird's eye view from the 2016 American Heart Association Scientific Sessions. J Nucl Cardiol 2017; 24:946-951. [PMID: 28205073 DOI: 10.1007/s12350-017-0822-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 12/23/2022]
Abstract
This review summarizes key imaging studies that were presented in the American Heart Association Scientific Sessions 2016 related to the fields of nuclear cardiology, cardiac computed tomography, cardiac magnetic resonance, and echocardiography. This bird's eye view will inform readers about multiple studies from these different modalities. We hope that this general overview will be useful for those that did not attend the conference as well as to those that did since it is often difficult to get exposure to many abstracts at large meetings. The review, therefore, aims to help readers stay updated on the newest imaging studies presented at the meeting.
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Affiliation(s)
- Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Steven G Lloyd
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Fadi G Hage
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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47
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Ziadi MC. Myocardial flow reserve (MFR) with positron emission tomography (PET)/computed tomography (CT): clinical impact in diagnosis and prognosis. Cardiovasc Diagn Ther 2017; 7:206-218. [PMID: 28540215 DOI: 10.21037/cdt.2017.04.10] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In recent years, radionuclide myocardial perfusion imaging (MPI) using positron emission tomography/computed tomography (PET/CT) has emerged as a robust tool for the diagnosis, risk stratification and management of patients with known or established coronary artery disease (CAD). Cardiac PET/CT imaging affords key advantages compared to single photon emission computed tomography (SPECT) that encompass: (I) improved diagnostic accuracy; (II) decreased radiation exposure due to the utilization of short-lived radiopharmaceuticals, and importantly; (III) the ability to quantify noninvasively myocardial blood flow (MBF) in absolute terms, that is in ml per minute per gram of tissue. Quantitative approaches that measure MBF with PET can facilitate the diagnosis of multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. The aim of this review is to focus on the potential clinical utility of MBF and will discuss: (I) basics aspects of PET clinical perfusion tracers and flow quantification parameters; (II) limitations of relative MPI, (III) summarize a classification of diseases where flow quantification may be of use; (IV) specifically, review data on the diagnosis and prognostic value of flow quantification.
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Affiliation(s)
- Maria Cecilia Ziadi
- Non-Invasive Cardiovascular Imaging Department, Diagnóstico Médico Oroño, Rosario, Santa Fe, Argentina
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48
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O' Doherty J, McGowan DR, Abreu C, Barrington S. Effect of Bayesian-penalized likelihood reconstruction on [13N]-NH3 rest perfusion quantification. J Nucl Cardiol 2017; 24:282-290. [PMID: 27435278 PMCID: PMC5084874 DOI: 10.1007/s12350-016-0554-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/05/2016] [Indexed: 01/07/2023]
Abstract
ABSTACT OBJECTIVES: Myocardial blood flow (MBF) imaging is used in patients with suspected cardiac sarcoidosis, and also in stress/rest studies. The accuracy of MBF is dependent on imaging parameters such as new reconstruction methodologies. In this work, we aim to assess the impact of a novel PET reconstruction algorithm (Bayesian-penalized likelihood-BPL) on the values determined from the calculation of [13N]-NH3 MBF values. METHODS Data from 21 patients undergoing rest MBF evaluation [13N]-NH3 as part of sarcoidosis imaging were retrospectively analyzed. Each scan was reconstructed with a range of BPL coefficients (1-500), and standard clinical FBP and OSEM reconstructions. MBF values were calculated via an automated software routine for all datasets. RESULTS Reconstruction of [13N]-NH3 dynamic data using the BPL, OSEM, or FBP reconstruction showed no quantitative differences for the calculation of territorial or global MBF (P = .97). Image noise was lower using OSEM or BPL reconstructions than FBP and noise from BPL reached levels seen in OSEM images between B = 300 and B = 400. Intrasubject differences between all reconstructions over all patients in respect of all cardiac territories showed a maximum coefficient of variation of 9.74%. CONCLUSION Quantitation of MBF via kinetic modeling of cardiac rest MBF by [13N]-NH3 is minimally affected by the use of a BPL reconstruction technique, with BPL images presenting with less noise.
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Affiliation(s)
- Jim O' Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor, Lambeth Wing, London, SE1 7EH, United Kingdom.
| | - Daniel R McGowan
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, United Kingdom
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, United Kingdom
| | - Carla Abreu
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor, Lambeth Wing, London, SE1 7EH, United Kingdom
| | - Sally Barrington
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, 1st Floor, Lambeth Wing, London, SE1 7EH, United Kingdom
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Slomka PJ, Alessio AM, Germano G. How to reconstruct dynamic cardiac PET data? J Nucl Cardiol 2017; 24:291-293. [PMID: 27473215 DOI: 10.1007/s12350-016-0608-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| | - Adam M Alessio
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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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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