Comparison of Positron Emission Tomography Measurement of Adenosine-Stimulated Absolute Myocardial Blood Flow Versus Relative Myocardial Tracer Content for Physiological Assessment of Coronary Artery Stenosis Severity and Location

Abstract

Measurement of Ado-stimulated absolute MBF is superior to relative measurement of myocardial tracer retention for identification of CAD and can be accomplished with a single MBFado measurement.

Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC

“…[85][86][87] • In general, hyperemic MBF and MFR are relatively preserved for coronary lesions with less than 70% angiographic stenosis or with preserved fractional flow reserve (FFR) ([ 0.8). 45,47,51,52,[85][86][87][88][89]91,141,142 However, both Figure 7. Receiver-operator characteristic curves for detection of severe CAD using MFR.…”

“…Stress-first or stress-only imaging is feasible, but it is not routine practice with quantitative PET. Although several studies have suggested that peak hyperemic MBF is superior to MFR, [45][46][47] most studies have concluded that MFR is more powerful for risk stratification, [48][49][50][51][52][53] perhaps because of decreased variability compared with peak hyperemic MBF. 54 Whether postischemic stunning affects resting MBF with stressfirst imaging has not been well studied.…”

“…45,47 This suggests that stress-only imaging may be effective in selected patients, especially those without known CAD and normal left ventricular ejection fraction in whom resting MPI may be unnecessary to assess defect reversibility.…”

Absolute myocardial blood flow quantification with SPECT/CT: Is it possible?

“…They have been shown to provide clinically useful information beyond that provided by the assessment of relative perfusion defects in a variety of ways. These variables can potentially identify multivessel coronary artery disease (CAD) and predict the extent of disease more accurately than relative quantification or visual analysis of myocardial perfusion imaging (MPI), 1,2 which are the clinical standards today. The ability to quantify absolute MBF with stress MPI may permit improved identification of patients in whom the relative regional distribution of tracer may appear normal because of a balanced reduction of blood flow.…”

“…One key advantage of the Rb-82 tracer is the possibility of back-to-back stress and rest imaging in one scanning session due to the 75 seconds half life of Rb-82. 1 The Tc-99m protocol followed by Klein et al employed a 3-hour delay between stress and rest scans to reduce interference of the stress activity with rest scans. It also required delay of the acquisition for the static perfusion scans.…”