Combined evaluation of myocardial perfusion and coronary morphology in the identification of subclinical CAD (original) (raw)
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Diagnostic Value of 13N-Ammonia Myocardial Perfusion PET: Added Value of Myocardial Flow Reserve
Journal of Nuclear Medicine, 2012
The ability to obtain quantitative values of flow and myocardial flow reserve (MFR) has been perceived as an important advantage of PET over conventional nuclear myocardial perfusion imaging (MPI). We evaluated the added diagnostic value of MFR over MPI alone as assessed with 13 N-ammonia and PET/CT to predict angiographic coronary artery disease (CAD). Methods: Seventy-three patients underwent 1-d adenosine stress-rest 13 N-ammonia PET/CT MPI, and MFR was calculated. The added value of MFR as an adjunct to MPI for predicting CAD (luminal narrowing $ 50%) was evaluated using invasive coronary angiography as a standard of reference. Results: Per patient, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MPI for detecting significant CAD were 79%, 80%, 91%, 59%, and 79%, respectively. Adding a cutoff of less than 2.0 for global MFR to MPI findings improved the values to 96% (P , 0.005), 80%, 93%, 89% (P , 0.005), and 92% (P , 0.005), respectively. Conclusion: The quantification of MFR in 13 N-ammonia PET/CT MPI provides a substantial added diagnostic value for detection of CAD. Particularly in patients with normal MPI results, quantification of MFR helps to unmask clinically significant CAD.
Clinical Myocardial Perfusion PET/CT
Journal of Nuclear Medicine, 2007
The field of nuclear cardiology is witnessing growing interest in the use of cardiac PET for the evaluation of patients with coronary artery disease (CAD). The available evidence suggests that myocardial perfusion PET provides an accurate means for diagnosing obstructive CAD, which appears superior to SPECT especially in the obese and in those undergoing pharmacologic stress. The ability to record changes in left ventricular function from rest to peak stress and to quantify myocardial perfusion (in mL/min/g of tissue) provides an added advantage over SPECT for evaluating multivessel CAD. There is growing and consistent evidence that gated myocardial perfusion PET also provides clinically useful risk stratification. Although the introduction of hybrid PET/CT technology offers the exciting possibility of assessing the extent of anatomic CAD (CT coronary angiography) and its functional consequences (ischemic burden) in the same setting, there are technical challenges in the implementation of CT-based transmission imaging for attenuation correction. Nonetheless, this integrated platform for assessing anatomy and biology offers a great potential for translating advances in molecularly targeted imaging into humans.
PET-Myocardial Perfusion Imaging in the Assessment of Coronary Artery Disease: the basics
Clinical Research and Trials
PET Myocardial Perfusion Imaging is one of the most useful tools for clinicians when assessing coronary artery disease, due to its increasing availability, it is of superb importance to recognize the physiological basis and the basic principles for its interpretation. The most common protocols make use of Rubidium or Ammonia as radiotracers to evaluate myocardial perfusion and these agents have different characteristics, one caveat of Ammonia is that an on-site cyclotron is needed due to its short half-life. PET-MPI exhibits abnormalities not only on epicardial arteries but also in the microcirculation, as well as other parameters such as left ventricle ejection fraction and coronary flow reserve. Hybrid studies combine a functional with an anatomical study (i.e. PET-MPI and coronary computed tomography, respectively) and allows for a more complete evaluation of patients and to predict outcomes with great quality..
European Journal of Nuclear Medicine and Molecular Imaging, 2010
Purpose The aim of this study was to evaluate whether ECG-triggered coronary calcium scoring (CCS) scans can be used for attenuation correction (AC) to quantify myocardial blood flow (MBF) and coronary flow reserve (CFR) assessed by PET/CT with 13 N-ammonia. Methods Thirty-five consecutive patients underwent a 13 Nammonia PET/CT scan at rest and during standard adenosine stress. MBF values were calculated using AC maps obtained from the ECG-triggered CCS scan during inspiration and validated against MBF values calculated using standard non-gated transmission scans for AC. CFR was calculated as the ratio of hyperaemic over resting MBF. In all 35 consecutive patients intraobserver variability was assessed by blinded repeat analysis for both AC methods. Results There was an excellent correlation between CT AC and CCS for global MBF values at rest (n=35, r=0.94, p< 0.001) and during stress (n=35, r=0.97, p<0.001) with narrow Bland-Altman (BA) limits of agreement (−0.21 to 0.10 ml/min per g and −0.41 to 0.30 ml/min per g) as well as for global CFR (n=35, r=0.96, p<0.001, BA −0.27 to 0.34). The excellent correlation was preserved on the segmental MBF analysis for both rest and stress (n=1190, r=0.93, p<0.001, BA −0.60 to 0.50) and for CFR (n=595, r=0.87, p<0.001, BA −0.71 to 0.74). In addition, reproducibility proved excellent for global CFR by CT AC (n=35, r=0.91, p<0.001, BA −0.42-0.58) and CCS scans (n=35, r=0.94, p<0.001, BA −0.34-0.45). Conclusion Use of attenuation maps from CCS scans allows accurate quantitative MBF and CFR assessment with 13 N-ammonia PET/CT.
Radiation Dose Assessment for Myocardial Perfusion Imaging: A Single Institution Survey
Tomography
Objective: This study aims to establish a local diagnostic reference level (LDRL) for single-photon emission tomography/computed tomography (SPECT/CT) and positron emission tomography/CT (PET/CT) with respect to myocardial perfusion imaging (MPI). Materials and Methods: The acquisition protocol and dosimetry data on the MPI procedures of five SPECT/CT scans and one PET/CT scan were collected. Data on technitum-99m sestamibi (99mTc-sestamibi), 99mTc-tetrofosmin, thallium-201 (201Tl), and rubidium-82 (82RB) were all collected from one centre via questionnaire booklets. Descriptive data analysis was used to analyse all variables, and the 50th percentile was used to analyse each radiation dose quantity. Results: The reported 50th percentile dose for a one-day stress/rest protocol using 99mTc-sestamibi (445/1147 MBq) and 99mTc-tetrofosmin (445/1147 MBq) and for a two-day stress/rest protocol using 99mTc-sestamibi (1165/1184 MBq) and 99mTc-tetrofosmin (1221/1184 MBq) are in good agreement...
Assessment of myocardial perfusion and function with PET and PET/CT
Journal of Nuclear Cardiology, 2010
There are several excellent review articles that detail the clinical applications, PET radiotracers, 1 quantitative PET, 2 viability assessment, 3 and utility of hybrid PET MPI applications. The focus of this article is to discuss the evolution of PET MPI over the course of the years to highlight some of the major achievements in PET that have culminated in the present day applications of PET MPI.