Accuracy of low-dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and normal database interpretation

Kaster, Tyler S.; Mylonas, Ilias; Renaud, Jennifer; Wells, George A.; deKemp, Robert A.

doi:10.1007/s12350-012-9621-y

Cited by 42 publications

(35 citation statements)

References 27 publications

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“…Overall agreement might be further improved using scannerspecific 82 Rb normal databases to assign default segmental scores, reducing the need for user modification and decreasing interoperator variability. We recently reported the accuracy of lowdose 82 Rb MPI using a 3D PET/CT normal database (8), showing results similar to standard-dose imaging (15) and traditional 2D PET methods. Consistent scan interpretation between recruiting centers is essential to permit pooling of the data for further evaluation of the rubidium-ARMI endpoints of clinical outcomes and cost-effectiveness.…”

Section: Discussionmentioning

confidence: 70%

“…Standards were established using the Discovery 690 PET/CT system (GE Healthcare) at the core site (University of Ottawa Heart Institute) (8,9). Qualifying scans simulating normal rest and abnormal stress 82 Rb MPI were then obtained at all sites using an anthropomorphic torso phantom (Data Spectrum) to standardize reconstructed image resolution, perfusion defect contrast, and CT attenuation correction (CTAC) image alignment.…”

Section: Qualifying Scansmentioning

confidence: 99%

“…82 Rb is an alternative isotope with the lowest radiation dose among perfusion imaging tracers (0.7-1.3 mSv/GBq) (3,4) and is considered to have superior accuracy and incremental prognostic value (5)(6)(7)(8)(9)(10).…”

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confidence: 99%

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Clinical Interpretation Standards and Quality Assurance for the Multicenter PET/CT Trial Rubidium-ARMI

et al. 2013

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Rubidium-ARMI ( 82 Rb as an Alternative Radiopharmaceutical for Myocardial Imaging) is a multicenter trial to evaluate the accuracy, outcomes, and cost-effectiveness of low-dose 82 Rb perfusion imaging using 3-dimensional (3D) PET/CT technology. Standardized imaging protocols are essential to ensure consistent interpretation. Methods: Cardiac phantom qualifying scans were obtained at 7 recruiting centers. Low-dose (10 MBq/kg) rest and pharmacologic stress 82 Rb PET scans were obtained in 25 patients at each site. Summed stress scores, summed rest scores, and summed difference scores (SSS, SRS, and SDS [respectively] 5 SSS-SRS) were evaluated using 17-segment visual interpretation with a discretized color map. All scans were coread at the core lab (University of Ottawa Heart Institute) to assess agreement of scoring, clinical diagnosis, and image quality. Scoring differences greater than 3 underwent a third review to improve consensus. Scoring agreement was evaluated with intraclass correlation coefficient (ICC-r), concordance of clinical interpretation, and image quality using k coefficient and percentage agreement. Patient 99m Tc and 201 Tl SPECT scans (n 5 25) from 2 centers were analyzed similarly for comparison to 82 Rb. Results: Qualifying scores of SSS 5 2, SDS 5 2, were achieved uniformly at all imaging sites on 9 different 3D PET/CT scanners. Patient scores showed good agreement between core and recruiting sites: ICC-r 5 0.92, 0.77 for SSS, SDS. Eighty-five and eighty-seven percent of SSS and SDS scores, respectively, had site-core differences of 3 or less. After consensus review, scoring agreement improved to ICC-r 5 0.97, 0.96 for SSS, SDS (P , 0.05). The agreement of normal versus abnormal (SSS $ 4) and nonischemic versus ischemic (SDS $ 2) studies was excellent: ICC-r 5 0.90 and 0.88. Overall interpretation showed excellent agreement, with a k 5 0.94. Image quality was perceived differently by the site versus core reviewers (90% vs. 76% good or better; P , 0.05). By comparison, scoring agreement of the SPECT scans was ICC-r 5 0.82, 0.72 for SSS, SDS. Seventy-six and eighty-eight percent of SSS and SDS scores, respectively, had site-core differences of 3 or less. Consensus review again improved scoring agreement to ICC-r 5 0.97, 0.90 for SSS, SDS (P , 0.05). Conclusion: 82 Rb myocardial perfusion imaging protocols were implemented with highly repeatable interpretation in centers using 3D PET/CT technology, through an effective standardization and quality assurance program. Site scoring of 82 Rb PET myocardial perfusion imaging scans was found to be in good agreement with core lab standards, suggesting that the data from these centers may be combined for analysis of the rubidium-ARMI endpoints.

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Section: Discussionmentioning

confidence: 70%

Section: Qualifying Scansmentioning

confidence: 99%

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Clinical Interpretation Standards and Quality Assurance for the Multicenter PET/CT Trial Rubidium-ARMI

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“…7 Some generator systems do allow for adjusting patient doses without recalibrating the infusion system; however, clinicians should verify this capability with the generator manufacturer before using a weight-adjusted dosing protocol. 8,38,39 Weight-adjusted dosages for 13 N-ammonia are not typically recommended. Although it can lower patient dose, the increased handling and the uncertainty of when a patient is ready for imaging make weight adjustment difficult.…”

Section: Weight-adjusted Tracer Activitiesmentioning

confidence: 99%

Status of cardiovascular PET radiation exposure and strategies for reduction: An Information Statement from the Cardiovascular PET Task Force

Case

deKemp

Slomka

et al. 2017

Journal of Nuclear Cardiology

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Cardiovascular positron emission tomography (PET) imaging provides high-quality visual and quantitative myocardial perfusion and function images. In addition, cardiovascular PET can assess myocardial viability, myocardial inflammatory disorders such as cardiac sarcoid, and infections of implanted devices including pacemakers, ventricular assist devices, and prosthetic heart valves. As with all nuclear cardiology procedures, the benefits need to be considered in relation to the risks of exposure to radiation. When performed properly, these assessments can be obtained while simultaneously minimizing radiation exposure. The purpose of this information statement is to present current concepts to minimize patient and staff radiation exposure while ensuring high image quality.

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“…7 The authors evaluated a total of 70 patients with coronary angiography correlation and 77 patients with low likelihood (LLk) of CAD to assess the diagnostic accuracy of low-dose 3D 82 Rb-PET (weight-dependent 10 MBq/kg, translating from the SI units for the US audience, approximately 0.12 mCi/lb). Automatic relative quantification (with automatically derived summed stress scores) and quantification of transient ischemic dilation (TID) were used, without absolute flow measurements and without visual reading by the physicians.…”

Section: Articlementioning

confidence: 99%

Low-dose 3D 82Rb PET

Slomka

Berman

Germano

2012

Journal of Nuclear Cardiology

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3D PET TECHNOLOGY3D PET systems were introduced for oncological imaging almost a decade ago and are now universally used. The principal advantage of the 3D PET acquisition (accepting photons from all angles) over the 2D PET with parallel septa is much higher sensitivity (4-6 times) for photon detection, albeit at the cost of increased scatter fraction and more complex image reconstruction. 1 3D 82 Rb PET acquisition has presented image quality problems due to increased random events when previous generation 2D-3D BGO scanners were used. 2 Furthermore, until recently, the interference of prompt gamma emission during 82 Rb decay with scatter correction on 3D systems was not fully recognized. 3 Most literature in cardiac PET imaging describes studies performed in 2D mode. 4 However, currently the users of new PET/CT equipment are unable to acquire images in 2D since almost all new scanners operate in 3D mode only and come without septa. Therefore, the optimal use of such 3D PET/CT for cardiac imaging and in particular for 82 Rb imaging is of great interest to the nuclear cardiology community. IMPORTANCE OF LOW-DOSE PETThe increased sensitivity of the new 3D PET/CT systems can be utilized to reduce radiation exposure to the patient during the myocardial perfusion imaging scan. Although the true effect of radiation exposures lower than 100 mSv on cancer risk is unknown as the risk estimates are extrapolated linearly from higher doses, 5,6 radiation exposure and discussion of cardiac imaging's contribution to hypothetical (but possible) cancer have been recently highlighted. Therefore, from the patient's perspective, radiation exposure ''as low as reasonably achievable'' is very desirable. ARTICLEThe accuracy of low-dose 3D PET/CT for detecting coronary artery disease (CAD) was assessed in an article by Kaster et al in this issue of the Journal of Nuclear Cardiology. 7 The authors evaluated a total of 70 patients with coronary angiography correlation and 77 patients with low likelihood (LLk) of CAD to assess the diagnostic accuracy of low-dose 3D 82 Rb-PET (weight-dependent 10 MBq/kg, translating from the SI units for the US audience, approximately 0.12 mCi/lb). Automatic relative quantification (with automatically derived summed stress scores) and quantification of transient ischemic dilation (TID) were used, without absolute flow measurements and without visual reading by the physicians. They report that by automated analysis they achieved perfect sensitivity (100%) and 48% specificity for the detection of obstructive stenosis in the angiographic group. The specificity improved to 78% without sensitivity loss in a subgroup (n = 45) excluding patients with acute myocardial infarction and low ejection fraction. It should be noted that to achieve 100% sensitivity, the authors modify perfusion abnormality thresholds depending on the TID variable. The sensitivity was 95% by perfusion analysis alone. The receiver operator characteristics areas under-curve (ROC-AUC) ranged from 0.92 to 0.97. As expected with relative perfu...

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Accuracy of low-dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and normal database interpretation

Abstract: A normal database containing the relative perfusion scores of patients with LLK of CAD can be used to accurately diagnose obstructive coronary disease using low-dose Rb-82 with 3D PET-CT imaging.

Cited by 42 publications

References 27 publications

Clinical Interpretation Standards and Quality Assurance for the Multicenter PET/CT Trial Rubidium-ARMI

Clinical Interpretation Standards and Quality Assurance for the Multicenter PET/CT Trial Rubidium-ARMI

Status of cardiovascular PET radiation exposure and strategies for reduction: An Information Statement from the Cardiovascular PET Task Force

Low-dose 3D 82Rb PET

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