Washout of 82Rb as a marker of impaired tissue integrity, obtained by list-mode cardiac PET/CT: relationship with perfusion/metabolism patterns of myocardial viability (original) (raw)
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Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2005
PET is a sensitive technique for the identification of viable myocardial tissue in patients with coronary disease. Metabolic assessment with (18)F-FDG is considered the gold standard for assessment of viability before surgical revascularization. Prior research has suggested that viability may be assessed with washout of (82)Rb between early and late resting images. Our objective was to determine whether assessment of myocardial viability with (82)Rb washout is reliable when compared with PET using (18)F-FDG. We performed PET for 194 patients referred for PET (18)F-FDG/(82)Rb to assess viability for clinical indications. We included 151 patients with resting defects >10% of the left ventricle (LV) (n = 159 defects). Patients with smaller resting (82)Rb defects (<10% LV) were excluded for the purpose of this study. PET images acquired with (82)Rb and (18)F-FDG defined viability by the mismatch between metabolism and perfusion ((18)F-FDG >125% of (82)Rb uptake in the (82)Rb de...
Delineation of myocardial viability with PET
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1995
Relative flow and metabolic imaging (the "mismatch pattern") with PET have been proposed to identify the presence of viable myocardium in patients with ischemic left ventricular dysfunction. Yet, optimal criteria to identify dysfunctional but viable myocardium and predict significant functional improvement have not been fully defined. Dynamic PET imaging with 13N-ammonia and 18F-deoxyglucose to assess absolute myocardial perfusion and glucose uptake was performed in 25 patients (20 men, 5 women; mean age 57 +/- 12 yr, range 30-72 yr) scheduled for coronary revascularization because of coronary artery disease, anterior wall dysfunction and mildly depressed left ventricular ejection fraction (49% +/- 11%). Global and regional left ventricular function was evaluated by contrast left ventriculography at baseline and after revascularization. As judged from the changes in end-systolic volume and resting anterior wall motion before and after revascularization, 17 patients with im...
Journal of Nuclear Medicine, 2012
In myocardial perfusion SPECT, transient ischemic dilation ratio (TID) is a well-established marker of severe ischemia and adverse outcome. However, its role in the setting of 82 Rb PET is less well defined. Methods: We analyzed 265 subjects who underwent clinical rest-dipyridamole 82 Rb PET/CT. Sixty-two subjects without a prior history of cardiac disease and with a normal myocardial perfusion study had either a low or a very low pretest likelihood of coronary artery disease or negative CT angiography. These subjects were used to establish a reference range of TID. In the remaining 203 patients with an intermediate or high pretest likelihood, subgroups with normal and abnormal TID were established and compared with respect to clinical variables, perfusion defect scores, left ventricular function, and absolute myocardial flow reserve. Follow-up was obtained for 969 6 328 d to determine mortality by review of the social security death index. Results: In the reference group, TID ratio was 0.98 6 0.06. Accordingly, a threshold for abnormal TID was set at greater than 1.13 (0.98 1 2.5 SDs). In the study group, 19 of 203 patients (9%) had an elevated TID ratio. Significant differences between subgroups with normal and abnormal TID ratio were observed for ejection fraction reserve (5.0 6 6.4 vs. 1.8 6 7.9; P , 0.05), difference between end-systolic volume (ESV) at rest and stress (ΔESV[stress-rest]; 1.8 6 7.4 vs. 12.3 6 13.0 mL; P , 0.0001), difference between end-diastolic volume (EDV) at rest and stress (ΔEDV[stress-rest]; 10.8 6 11.5 vs. 23.8 6 14.6 mL; P , 0.0001), summed rest score (1.8 6 3.8 vs. 3.8 6 7.6; P , 0.05), summed stress score (3.0 6 5.4 vs. 7.5 6 9.8; P , 0.002), summed difference score (1.3 6 2.6 vs. 3.7 6 5.3; P , 0.02), and global myocardial flow reserve (2.1 6 0.8 vs. 1.7 6 0.6; P , 0.02). Additionally, TID-positive patients had a significantly lower overall survival probability (P , 0.05). In a subgroup analysis of patients without regional perfusion abnormalities, TID-positive patients' overall survival probability was significantly smaller (P , 0.03), and TID was an independent predictor (exponentiation of the B coefficients [Exp(b)] 5 6.22; P , 0.009) together with an ejection fraction below 45% (Exp[b] 5 6.16; P , 0.002). Conclusion: The present study suggests a reference range of TID for 82 Rb PET myocardial perfusion imaging that is in the range of previously established values for SPECT. Abnormal TID in 82 Rb PET is associated with more extensive left ventricular dysfunction, ischemic compromise, and reduced global flow reserve. Preliminary outcome analysis suggests that TID-positive subjects have a lower overall survival probability.
Quantitative 82Rb PET/CT: Development and Validation of Myocardial Perfusion Database
Journal of Nuclear Medicine, 2007
Database Rb PET/CT: Development and Validation of Myocardial Perfusion 82 Quantitative http://jnm.snmjournals.org/content/48/7/1122 This article and updated information are available at: http://jnm.snmjournals.org/site/subscriptions/online.xhtml Information about subscriptions to JNM can be found at: http://jnm.snmjournals.org/site/misc/permission.xhtml
Journal of Nuclear Cardiology, 2010
Background. Relative myocardial perfusion imaging may underestimate severity of coronary disease (CAD), particularly in cases of balanced ischemia. Can quantification of peak left (LV) and right (RV) ventricular Rb-82 uptake measurements identify patients with left main or 3 vessel disease? Methods. Patients (N 5 169) who underwent Rb-82 PET MPI and coronary angiography were categorized as having no significant coronary stenosis (n 5 60), 1 or 2 vessel disease (n 5 81), or left main disease/3 vessel disease (n 5 28), based on angiography. Maximal LV and RV ventricular myocardial Rb-82 uptake was measured during stress and rest. Results. Failure to augment LV uptake by ‡ 8500 Bq/cc at stress, predicted left main or 3 vessel disease with a sensitivity of 93% and specificity of 61% (area under curve 5 0.83). A ‡10% increase in RV: LV uptake ratios with stress over rest was 93% specific (area under curve 5 0.74) for left main or 3 vessel disease. These indices incrementally predicted left main or 3 vessel disease compared to models including age, gender, cardiac risk factors, and summed stress and difference scores. Conclusion. Quantifying maximal rest and stress LV and RV uptake with PET myocardial perfusion imaging may independently and incrementally identify patients with left main or 3 vessel disease.
Journal of Nuclear Cardiology, 2004
Background Positron emission tomography (PET) flow/metabolic mismatch is considered the nuclear medicine gold standard for the assessment of myocardial viability. The aim of this study was to investigate whether baseline/nitrate technetium 99m tetrofosmin single photon emission computed tomography (SPECT) mismatch may provide equivalent clinical information. Methods and Results We studied 23 patients (aged 62 ± 10 years, 19 men) with previous myocardial infarction (16 anterior, 4 inferior, and 3 anterior plus inferior) and postischemic heart failure (gated SPECT [G-SPECT] ejection fraction, 26% ± 8%). All patients underwent Tc-99m tetrofosmin G-SPECT at rest and after nitrates (intravenous isosorbide dinitrate, 0.2 mg/mL, 10 mL/h) as well as a fluorine 18 fluoro-2-deoxy-D-glucose (FDG) PET scan. Regional wall motion analysis was performed with quantitative G-SPECT (QGS). Myocardial dysfunction was defined as a regional QGS score of 2 or greater. Regional perfusion was assessed by quantitative perfusion score (QPS) providing percent Tc-99m tetrofosmin uptake in a 20-segment model. Semiquantitative analysis of FDG uptake was performed by use of polar maps generated by Siemens ECAT HR software. In areas with a perfusion rate lower than 80%, PET viability was identified by a normalized FDG percent uptake/baseline Tc-99m tetrofosmin percent uptake ratio greater than 1.2. We analyzed 460 segments; 298 (64%) were dysfunctional by QGS analysis. Of these, 170 were viable by PET imaging whereas 128 were nonviable. Regional Tc-99m tetrofosmin uptake was higher in viable than in nonviable segments both at rest (60% ± 24% vs 42% ± 12%, P <.01) and after nitrates (67% ± 20% vs 41% ± 18%, P <.01). According to receiver operating characteristic curve analysis, a cutoff value of 63% for resting as well as post-nitrate G-SPECT provided the highest diagnostic accuracy for the detection of myocardial viability (67% and 72% at rest and after nitrates, respectively). When the same algorithm used for the comparison with PET (normalized nitrate percent uptake/ baseline percent uptake) was applied to G-SPECT, we obtained the highest agreement with PET (accuracy, 93%; sensitivity, 95%; specificity, 92%). Conclusions In patients with severe left ventricular dysfunction, perfusion data alone, both at rest and after nitrates, do not allow an accurate estimate of myocardial viability. In dysfunctioning segments, the analysis of rest/post-nitrate Tc-99m tetrofosmin mismatch provides results similar to those obtained by PET flow/metabolic mismatch. (J Nucl Cardiol 2004;11:142-51.)
Reversible 18-FDG-uptake defects on myocardial PET: Is this myocardial resurrection?
International Journal of Cardiology, 2008
Because it can accurately detect preserved glucose metabolism even in the hypoperfused or stunned myocardium, 18-FDG-PET is considered as the gold standard of myocardial viability assessment. In tako-tsubo cardiomyopathy, a presumed condition of stunning, absence of glucose metabolism however is not a marker of death. This sheds a critical light on 18-FDG-PET as a gold standard for viability.
Myocardial viability assessment in 18FDG PET/CT study (18FDG PET myocardial viability assessment)
Nuclear Medicine Review, 2012
Accurate identification of viable myocardium is crucial in patient qualification for medical or surgical treatment. Only persons with confirmed cardiac viability will benefit from revascularization procedures. It is also well known, that the amount of viable myocardium assessed preoperatively is the best indicator of long term cardiac event free survival after cardiac intervention.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2014
The quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR) using PET with (82)Rb in patients with known or suspected coronary artery disease has been demonstrated to have substantial prognostic and diagnostic value. However, multiple methods for estimation of an image-derived input function and several models for the nonlinear first-pass extraction of (82)Rb by myocardium have been used. We sought to compare the differences in these methods and models and their impact on prognostic assessment in a large clinical dataset. Consecutive patients (n = 2,783) underwent clinically indicated rest-stress myocardial perfusion PET with (82)Rb. The input function was derived using a region of interest (ROI) semiautomatically placed in the region of the mitral valve, factor analysis, and a hybrid method that creates an ROI from factor analysis. We used 5 commonly used extraction models for (82)Rb to estimate MBF and MFR. Pearson correlations, bias, and Cohen κ were compu...