Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 12/2021

01-11-2021 | Arterial Diseases | Original Article

Effects of two patient-specific dosing protocols on measurement of myocardial blood flow with 3D 82Rb cardiac PET

Authors: Liliana Arida-Moody, Jonathan B Moody, Jennifer M Renaud, Alexis Poitrasson-Rivière, Tomoe Hagio, Anne M Smith, Edward P Ficaro, Venkatesh L Murthy

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2021

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Murthy VL, Bateman TM, Beanlands RS, et al. Clinical quantification of myocardial blood flow using PET: joint position paper of the SNMMI cardiovascular council and the ASNC. J Nucl Cardiol. 2018;25:269–97.CrossRef
2.
3.
Gould KL, Johnson NP, Bateman TM, et al. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol. 2013;62(18):1639–53.CrossRef
4.
Schindler TH. Myocardial blood flow: putting it into clinical perspective. J Nucl Cardiol. 2016;23(5):1056–71.CrossRef
5.
Schindler TH, Dilsizian V. Coronary microvascular dysfunction: clinical considerations and noninvasive diagnosis. JACC Cardiovasc Imaging. 2020;13(1):140–55.CrossRef
6.
Tio RA, Dabeshlim A, Siebelink H-MJ, et al. Comparison between the prognostic value of left ventricular function and myocardial perfusion reserve in patients with ischemic heart disease. J Nucl Med. 2009;50(2):214–9.CrossRef
7.
Herzog BA, Husmann L, Valenta I, et al. Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography: added value of coronary flow reserve. J Am Coll Cardiol. 2009;54(2):150–6.CrossRef
8.
Ziadi MC, RA DK, Williams KA, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol. 2011;58(7):740–8.CrossRef
9.
Murthy VL, Naya M, Foster CR, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011;124(20):2215–24.CrossRef
10.
Farhad H, Dunet V, Bachelard K, Allenbach G, Kaufmann PA, Prior JO. Added prognostic value of myocardial blood flow quantitation in rubidium-82 positron emission tomography imaging. Eur Heart J Cardiovasc Imaging. 2013;14(12):1203–10.CrossRef
11.
Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG. Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med. 2003;349(11):1027–35.CrossRef
12.
Sciagrà R, Calabretta R, Cipollini F, et al. Myocardial blood flow and left ventricular functional reserve in hypertrophic cardiomyopathy: a 13NH3 gated PET study. Eur J Nucl Med Mol Imaging. 2017;44(5):866–75.CrossRef
13.
Hajjiri MM, Leavitt MB, Zheng H, Spooner AE, Fischman AJ, Gewirtz H. Comparison of positron emission tomography measurement of adenosine-stimulated absolute myocardial blood flow versus relative myocardial tracer content for physiological assessment of coronary artery stenosis severity and location. J Am Coll Cardiol Img. 2009;2(6):751–8.CrossRef
14.
Kajander S, Joutsiniemi E, Saraste M, et al. Clinical value of absolute quantification of myocardial perfusion with 15O-water in coronary artery disease. Circ Cardiovasc Imaging. 2011;4(6):678–84.CrossRef
15.
Ziadi MC, RA dK, Williams K, et al. Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? J Nucl Cardiol. 2012;19(4):670–80.CrossRef
16.
17.
Klein R, RA dK. Selection of PET camera and implications on the reliability and accuracy of absolute myocardial blood flow quantification. Curr Cardiol Rep. 2020;22(10).
18.
Moody JB, Lee BC, Corbett JR, Ficaro EP, Murthy VL. Precision and accuracy of clinical quantification of myocardial blood flow by dynamic PET: a technical perspective. J Nucl Cardiol. 2015;22(5):935–51.CrossRef
19.
Cerqueira MD, Allman KC, Ficaro EP, et al. Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol. 2010;17(4):709–18.CrossRef
20.
Fazel R, Gerber TC, Balter S, et al. Approaches to enhancing radiation safety in cardiovascular imaging. A scientific statement from the American Heart Association. Circulation. 2014;130(19):1730–48.CrossRef
21.
Case JA, RA dK, Slomka PJ, smith MF, Heller GV, Cerqueira MD. Status of cardiovascular PET radiation exposure and strategies for reduction: an information statement from the cardiovascular PET task force. J Nucl Cardiol. 2017;24(4):1427–39.CrossRef
22.
Tout D, Tonge C, Muthu S, Arumugam P. Assessment of a protocol for routine simultaneous myocardial blood flow measurement and standard myocardial perfusion imaging with rubidium-82 on a high count rate positron emission tomography system. Nucl Med Commun. 2012;33(11):1202–11.CrossRef
23.
24.
25.
Esteves FP, Nye JA, Khan A, et al. Prompt-gamma compensation in Rb-82 myocardial perfusion 3D PET/CT. J Nucl Cardiol. 2010;17(2):247–53.CrossRef
26.
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. 2016:1–10.
27.
Ficaro EP, Lee BC, Kritzman JN, Corbett JR. Corridor4DM: the Michigan method for quantitative nuclear cardiology. J Nucl Cardiol. 2007;14(4):455–65.CrossRef
28.
Renaud JM, Yip K, Guimond J, et al. Characterization of 3D PET systems for accurate quantification of myocardial blood flow. J Nucl Med. 2017;58(1):103–9.CrossRef
29.
Moody JB, Murthy VL, Lee BC, Corbett JR, Ficaro EP. Variance estimation for myocardial blood flow by dynamic PET. IEEE Trans Med Imaging. 2015;34(11):2343–53.CrossRef
30.
Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation. 2002;105(4):539–42.CrossRef
31.
Slomka PJ, Nishina H, Berman DS, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol. 2005;12(1):66–77.CrossRef
32.
Velilla S. A note on the multivariate box—cox transformation to normality. Stat Probab Lett. 1993;17(4):259–63.CrossRef
33.
Fox J, Weisberg S. An R companion to applied regression. Third edition. Thousand Oaks, California: SAGE Publications, Inc; 2019.
34.
35.
Fox J, Weisberg S. Visualizing fit and lack of fit in complex regression models with predictor effect plots and partial residuals. J Stat Softw. 2018;87(1):1–27.
36.
Virtanen P, Gommers R, Oliphant TE, et al. SciPy 1.0: fundamental algorithms for scientific computing in Python. Nat Methods. 2020;17(3):261–72.CrossRef
37.
Klein R, Ocneanu A, Renaud JM, Ziadi MC, Beanlands RSB, RA DK. Consistent tracer administration profile improves test–retest repeatability of myocardial blood flow quantification with 82Rb dynamic PET imaging. J Nucl Cardiol. 2016:1–13.
38.
Kitkungvan D, Johnson NP, Roby AE, Patel MB, Kirkeeide R, Gould KL. Routine clinical quantitative rest stress myocardial perfusion for managing coronary artery disease: clinical relevance of test-retest variability. JACC Cardiovasc Imaging. 2017;10(5):565–77.CrossRef
39.
40.
Case JA, Courter SA, Moloney E, Bateman TM. Evaluation of image quality, radiation dose and quantification of myocardial blood using a weight-based, constant activity Rb-82 infusion system In: Abstracts of Original Contributions ASNC2020. Springer. 2020.
41.
Metadata
Title
Effects of two patient-specific dosing protocols on measurement of myocardial blood flow with 3D 82Rb cardiac PET
Authors
Liliana Arida-Moody
Jonathan B Moody
Jennifer M Renaud
Alexis Poitrasson-Rivière
Tomoe Hagio
Anne M Smith
Edward P Ficaro
Venkatesh L Murthy
Publication date
01-11-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-021-05385-1

Other articles of this Issue 12/2021

European Journal of Nuclear Medicine and Molecular Imaging 12/2021 Go to the issue

Obituary

In memory of Amnon Piepsz

Review Article

Factors predicting biochemical response and survival benefits following radioligand therapy with [177Lu]Lu-PSMA in metastatic castrate-resistant prostate cancer: a review

Original Article

Targeting fibroblast activation protein in newly diagnosed squamous cell carcinoma of the oral cavity – initial experience and comparison to [18F]FDG PET/CT and MRI

Correction

Correction to: Functional 4-D clustering for characterizing intratumor heterogeneity in dynamic imaging: evaluation in FDG PET as a prognostic biomarker for breast cancer

Review Article

Imaging and liquid biopsy in the prediction and evaluation of response to PRRT in neuroendocrine tumors: implications for patient management

Original Article

68Ga-FAPI-PET/CT in patients with various gynecological malignancies