Clinical Applications of Myocardial Perfusion Assessments Made with Oxygen-15 Water and Positron Emission Tomography

Abstract

Positron emission tomography is an intrinsically quantitative tool which permits the quantitative assessment (i.e., in ml/g/min) of regional myocardial perfusion. Oxygen-15-labeled water is the only positron-emitting flow tracer which is freely diffusible within the myocardium. It has been used extensively to define normal myocardial perfusion physiology, as well as to delineate the effects of numerous cardiac diseases on myocardial perfusion and to assess the efficacy of therapeutic interventions. This brief review summarizes the major observations that have been made in humans using oxygen-15 water and positron emission tomography for quantitative estimation of regional myocardial perfusion.

Global myocardial blood flow and global flow reserve measurements by MRI and PET are comparable

“…The present study demonstrates that breath‐hold VEC MRI is a feasible and reliable method for measuring global MBF and global CFR. PET has been previously validated as a gold standard for CFR measurements and was used in the present study as a reference method (20). We found a good correlation of global MBF and CFR measured using MRI and PET methods.…”

“…PET using [ 15 O]‐labeled water as a tracer is currently regarded as the most accurate noninvasive approach for measuring regional CFR (20). PET is noninvasive and safe, whereas another reference method, invasive catheterization, possesses a potential risk for the patient.…”

“…Several methods have been established for measuring regional CFR in humans (19), but only invasive catheterization of the CS and positron emission tomo‐ graphy (PET) have been previously validated for measuring global MBF and global CFR. Currently, PET with [ 15 O]‐labeled water has been considered the gold standard for measuring CFR (20). However, both catheterization and PET methods cause radiation for the patient, and, furthermore, catheterization is an invasive method.…”

Coronary flow reserve: measurement with transthoracic Doppler echocardiography is reproducible and comparable with positron emission tomography

“…These methods include invasive Doppler (Graham et al ., 1990), semi‐invasive Doppler (Iliceto et al ., 1991) and non‐invasive Doppler (TTE) (Caiati et al ., 1999; Hozumi et al ., 1998a), positron emission tomography (PET) (Demer et al ., 1989) and magnetic resonance imaging (MRI) (Clarke et al ., 1995; Sakuma et al ., 1996). Currently, PET with oxygen‐15‐labelled water is regarded as the golden standard for measuring CFR (Bergmann, 1997). In contrast to the other methods, it is possible to measure regional and global CFR simultaneously using PET.…”

Myocardial first pass perfusion assessed by cardiac magnetic resonance and coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease

“…A significant proportion of these women have coronary microvascular dysfunction (CMD) which is increasingly recognized as a strong predictor of cardiovascular prognosis (2)(3)(4). The endothelial independent aspect of CMD can be assessed non-invasively by measuring coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE) (4,5) or by positron emission tomography (PET) measuring the myocardial blood flow reserve (MBFR) (3,6), the latter is considered the noninvasive gold standard of myocardial perfusion (7). Both PET and TTDE assessed CMD have shown to be strong prognostic markers (2-4), but both methods have limitations in terms of availability, technical skill requirements and radiation exposure.…”