Comparison of clinical non-commercial tools for automated quantification of myocardial blood flow using oxygen-15-labelled water PET/CT

Harms, Hendrik J.; Nesterov, Sergey V.; Han, Chong; Danad, Ibrahim; Leonora, Remigio; Raijmakers, Pieter; Lammertsma, Adriaan A.; Knuuti, Juhani; Knaapen, Paul

doi:10.1093/ehjci/jet177

Cited by 47 publications

(40 citation statements)

References 25 publications

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“…13,39,40 However, influence on the results cannot be entirely excluded because of the possible existence of significant offsets between different models, scan techniques, and reconstruction parameters. Furthermore, ratio measures, such as RFR, might be more robust to potential heterogeneity of these analyses in contrast to MBF.…”

Section: Study Limitationsmentioning

confidence: 99%

Relative Flow Reserve Derived From Quantitative Perfusion Imaging May Not Outperform Stress Myocardial Blood Flow for Identification of Hemodynamically Significant Coronary Artery Disease

Stuijfzand

Uusitalo

Kero

et al. 2015

Circ: Cardiovascular Imaging

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Background— Quantitative myocardial perfusion imaging is increasingly used for the diagnosis of coronary artery disease. Quantitative perfusion imaging allows to noninvasively calculate fractional flow reserve (FFR). This so-called relative flow reserve (RFR) is defined as the ratio of hyperemic myocardial blood flow (MBF) in a stenotic area to hyperemic MBF in a normal perfused area. The aim of this study was to assess the value of RFR in the detection of significant coronary artery disease. Methods and Results— From a clinical population of patients with suspected coronary artery disease who underwent oxygen-15–labeled water cardiac positron emission tomography and invasive coronary angiography, 92 patients with single- or 2-vessel disease were included. Intermediate lesions (diameter stenosis, 30%–90%; n=75) were interrogated by FFR. Thirty-eight (41%) vessels were deemed hemodynamically significant (>90% stenosis or FFR ≤0.80). Hyperemic MBF, coronary flow reserve, and RFR were lower for vessels with a hemodynamically significant lesion (2.01±0.78 versus 2.90±1.16 mL·min −1 ·g −1 ; P <0.001, 2.27±1.03 versus 3.10±1.29; P <0.001, and 0.67±0.23 versus 0.93±0.15; P <0.001, respectively). The correlation between RFR and FFR was moderate ( r =0.54; P <0.01). Receiver operator characteristic curve analysis showed an area under the curve of 0.82 for RFR, which was not significantly higher compared with that for hyperemic MBF and coronary flow reserve (0.76; P =0.32 and 0.72; P =0.08, respectively). Conclusions— Noninvasive estimation of FFR by quantitative perfusion positron emission tomography by calculating RFR is feasible, yet only a trend toward a slight improvement of diagnostic accuracy compared with hyperemic MBF assessment was determined.

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Section: Study Limitationsmentioning

confidence: 99%

Relative Flow Reserve Derived From Quantitative Perfusion Imaging May Not Outperform Stress Myocardial Blood Flow for Identification of Hemodynamically Significant Coronary Artery Disease

Stuijfzand

Uusitalo

Kero

et al. 2015

Circ: Cardiovascular Imaging

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“…[20][21][22][23][24] Software may be institution specific, especially for 15 O-water, 25 although commercial applications for each are now widely available. Although detailed discussion of the various models is beyond the scope of this review, certain points are addressed.…”

Section: N-ammonia Mbfmentioning

confidence: 99%

“…14,28 Clinical studies with 15 O-water or 13 N-ammonia may yield varying results for similar end points (eg, stress MBF threshold for flow-limiting stenosis) for technical or clinical reasons or both. 25 Nonetheless, the literature suggests that the absolute values of maximally stimulated MBF (adenosine) of ≈2 mL·min −1 ·g −1 will prove useful in identifying a flow-limiting coronary stenosis with 15 O-water or 13 N-ammonia. However, differences will be encountered, depending on a variety of factors.…”

Section: N-ammonia Mbfmentioning

confidence: 99%

Integration of Quantitative Positron Emission Tomography Absolute Myocardial Blood Flow Measurements in the Clinical Management of Coronary Artery Disease

Gewirtz

Dilsizian

2016

Circulation

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In the >40 years since planar myocardial imaging with 43 K-potassium was introduced into clinical research and management of patients with coronary artery disease (CAD), diagnosis and treatment have undergone profound scientific and technological changes. One such innovation is the current state-of-the-art hardware and software for positron emission tomography myocardial perfusion imaging, which has advanced it from a strictly research-oriented modality to a clinically valuable tool. This review traces the evolving role of quantitative positron emission tomography measurements of myocardial blood flow in the evaluation and management of patients with CAD. It presents methodology, currently or soon to be available, that offers a paradigm shift in CAD management. Heretofore, radionuclide myocardial perfusion imaging has been primarily qualitative or at best semiquantitative in nature, assessing regional perfusion in relative terms. Thus, unlike so many facets of modern cardiovascular practice and CAD management, which depend, for example, on absolute values of key parameters such as arterial and left ventricular pressures, serum lipoprotein, and other biomarker levels, the absolute levels of rest and maximal myocardial blood flow have yet to be incorporated into routine clinical practice even in most positron emission tomography centers where the potential to do so exists. Accordingly, this review focuses on potential value added for improving clinical CAD practice by measuring the absolute level of rest and maximal myocardial blood flow. Physiological principles and imaging fundamentals necessary to understand how positron emission tomography makes robust, quantitative measurements of myocardial blood flow possible are highlighted.

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“…The main problem at this step is the MBF variability due to (28,38), is to find a common denominator for the existing tools. In practice, it means the following: we doubt that it is currently feasible to single out 'the one' software solution, make everyone let go the tools they have been using for years already and switch to that one tool.…”

Section: Outputting the Valuesmentioning

confidence: 99%

The Status and Future of PET Myocardial Blood Flow Quantification Software

Nesterov

Lee²,

Moody³

et al. 2016

Annals of Nuclear Cardiology

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Comparison of clinical non-commercial tools for automated quantification of myocardial blood flow using oxygen-15-labelled water PET/CT

Cited by 47 publications

References 25 publications

Relative Flow Reserve Derived From Quantitative Perfusion Imaging May Not Outperform Stress Myocardial Blood Flow for Identification of Hemodynamically Significant Coronary Artery Disease

Relative Flow Reserve Derived From Quantitative Perfusion Imaging May Not Outperform Stress Myocardial Blood Flow for Identification of Hemodynamically Significant Coronary Artery Disease

Integration of Quantitative Positron Emission Tomography Absolute Myocardial Blood Flow Measurements in the Clinical Management of Coronary Artery Disease

The Status and Future of PET Myocardial Blood Flow Quantification Software

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