Detection of coronary artery disease with positron emission tomography and rubidium 82

Grover‐McKay, Maleah; Ratib, Osman; Schwaiger, Markus; Wohlgelernter, Daniel; Araujo, Luis I.; Nienaber, Christoph; Phelps, Michael E.; Schelbert, Heinrich R.

doi:10.1016/0002-8703(92)90502-m

Cited by 56 publications

(19 citation statements)

References 14 publications

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“…The PET/CT database quantification results reported here compare favorably with the studies using 82 Rb and PET in the literature (1,(15)(16)(17)(18)(19)(20), in which the sensitivity ranges from 83% to 95% and the specificity ranges from 82% to 100%. We were unable to find any prior publication using quantitative 82 Rb database analysis with PET/CT.…”

Section: Criteria For Abnormality and Prospective Validationsupporting

confidence: 69%

“…The summary of the literature (Table 2) shows that 946 patients have been studied using 82 Rb. Most of these studies (844 patients) were acquired using attenuation maps with 68 Ge ring sources, dipyridamole as a pharmacologic stressor, and stand-alone PET scanners (1,(15)(16)(17)(18)(19). More recently, a study has been published using a hybrid scanner (PET/CT), as in the present research, but using dipyridamole, adenosine, and dobutamine as pharmacologic stressors (20).…”

Section: Criteria For Abnormality and Prospective Validationmentioning

confidence: 99%

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Quantitative 82Rb PET/CT: Development and Validation of Myocardial Perfusion Database

Santana¹,

Folks²,

Garcia³

et al. 2007

Journal of Nuclear Medicine

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The use of myocardial perfusion 82 Rb PET/CT studies continues to increase but its accuracy using database quantification methods for the diagnosis of coronary artery disease (CAD) has not been established. Methods: A sex-independent normal database and criteria for abnormality for rest-stress 82 Rb PET/CT myocardial perfusion imaging were developed and validated by evaluation of 281 patients (136 females: mean age 6 SD, 63.3 6 13.3 y; 145 males: mean age 6 SD, 63.9 6 12.8 y) who underwent a rest-adenosine stress 82 Rb PET/CT study. These patients were divided into 3 groups: (a) healthy group: 30 patients, with ,5% likelihood of CAD (low likelihood [LLK]) based on sequential Bayesian analysis; these patients were used to generate the normal distribution; (b) pilot group: 174 patients; these patients were used to determine the optimal criteria for detecting and localizing the perfusion abnormality; and (c) validation group: 76 patients (23 with LLK of CAD and 53 who underwent coronary angiography; these patients were used for prospective validation. Results: Of the 53 patients who underwent coronary angiography, 8 had ,50% stenosis and 45 patients had at least one stenosis $50% in one major artery. Fifteen patients had single-vessel disease, 17 had double-vessel disease, and 13 had triple-vessel disease. The prospective validation shows a normalcy rate of 78% (18/23) for global CAD. The analyses by individual arteries show a normalcy rate of 96% (22/23) for the left anterior descending coronary artery, 96% for the left circumflex coronary artery (22/23), and 100% for the right coronary artery (23/23). The overall sensitivity for detection of CAD ($50% stenosis) was 93% (42/45). The overall specificity for detection of the absence of CAD (#50% stenosis) was 75% (6/8). Also, the positive predictive value for global CAD was 95% (42/44), the negative predictive value was 67% (6/9), and the accuracy was 91% (48/53). Conclusion: The quantitative 82 Rb PET/CT database created and validated in this study is highly accurate for the detection and localization of CAD. Physicians should consider using the quantitative output of these algorithms as decision support tools to aid with image interpretation. Rest -stress 82 Rb myocardial perfusion PET is widely regarded as a clinically accurate imaging modality for diagnosing and managing patients with coronary artery disease (CAD) (1,2). The reasons given for this high diagnostic performance are (a) the kinetic properties of 82 Rb, (b) the high sensitivity of a ring PET system, (c) the high-contrast resolution of PET scanners, and (d) the accurate attenuation correction used in PET (1-4). With the advent and wide dissemination of PET/CT scanners for cardiac imaging, high-quality transmission scans are generated by the CT scanner for attenuation correction.Although these PET/CT scanners yield high imaging performance, misregistration of the CT transmission and PET emission scans is often seen because of the different temporal resolution of the 2 modalities. Moreover, the transmi...

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Section: Criteria For Abnormality and Prospective Validationsupporting

confidence: 69%

Section: Criteria For Abnormality and Prospective Validationmentioning

confidence: 99%

Quantitative 82Rb PET/CT: Development and Validation of Myocardial Perfusion Database

Santana¹,

Folks²,

Garcia³

et al. 2007

Journal of Nuclear Medicine

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“…The very short half-life of 82 Rb, 76 s, and the relatively low myocardial extraction fraction result in image quality very similar to that provided by 99m Tc-based SPECT tracers. This tracer has been validated extensively and is being used clinically as a routine generator-produced radiopharmaceutical in the application of PETand PET/CT for the work-up of patients with CAD (19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Initial Characterization of an ¹⁸F-Labeled Myocardial Perfusion Tracer

Huisman¹,

Higuchi²,

Reder³

et al. 2008

J Nucl Med

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139

176

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PET allows for quantitative, regional myocardial perfusion imaging. The short half-lives of the perfusion tracers currently in use limit their clinical applicability. Here, the biodistribution and imaging quality of a new 18 F-labeled myocardial perfusion agent ( 18 F-BMS-747158-02) in an animal model are described. Methods: The biodistribution of 18 F-BMS-747158-02 was determined at 10 and 60 min after injection. The first-pass extraction fraction of the tracer was measured in isolated rat hearts perfused with the Langendorff method. Small-animal PET imaging was used to study tracer retention. Results: The biodistribution at 10 min after injection demonstrated high myocardial uptake (3.1 percentage injected dose per gram [%ID/g]) accompanied by little activity in the lungs (0.3 %ID/g) and liver (1.0 %ID/g). The tracer showed a high and flow-independent myocardial first-pass extraction fraction, averaging 0.94 (SD 5 0.04). PET imaging provided excellent delineation of myocardial structures. The heartto-lung activity ratio increased from 4.7 to 10.2 between 1 and 15 min after tracer injection (at rest). Adenosine infusion (140 mg/ kg/min) led to a significant increase in myocardial tracer retention (from 1.68 [SD 5 0.23]) s 21 to 3.21 [SD 5 0.92] s 21 ; P 5 0.03). Conclusion: The observation of a high and flow-independent first-pass extraction fraction promises linearity between tracer uptake and myocardial blood flow. Sustained myocardial tracer uptake, combined with high image contrast, will allow for imaging protocols with tracer injection at peak exercise followed by delayed imaging. Thus, 18 F-BMS-747158-02 is a promising new tracer for the quantitative imaging of myocardial perfusion and can be distributed to imaging laboratories without a cyclotron.

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“…The disadvantages of 82 Rb include the high energy of its positron (3.3 MeV) and a rather low extraction fraction (65%). However, PET imaging with 82 Rb has proven to be highly accurate in the detection and functional assessment of coronary artery stenoses and infarct size imaging [71,72].…”

Section: O-watermentioning

confidence: 99%

Imaging Techniques in Nuclear Cardiology for the Assessment of Myocardial Viability

Slart

Bax

Veldhuisen

et al. 2005

Int J Cardiovasc Imaging

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The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with sufficient viable myocardium, patients with predominantly scar tissue should be treated medically. Patients with left ventricular dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy (SPECT), whether using (201)thallium, (99m)Tc-sestamibi, or (99m)Tc-tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic and perfusion imaging with positron emission tomography (PET) radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization. New techniques in the nuclear cardiology field, like attenuation corrected SPECT, dual isotope simultaneous acquisition (DISA) SPECT and gated FDG PET are promising and will further improve the detection of myocardial viability. Also the combination of multislice computed tomography scanners with PET opens possibilities of adding coronary calcium scoring and non-invasive coronary angiography to myocardial perfusion imaging and quantification. Evaluation of the clinical role of these creative new possibilities warrants investigation.

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Detection of coronary artery disease with positron emission tomography and rubidium 82

Cited by 56 publications

References 14 publications

Quantitative 82Rb PET/CT: Development and Validation of Myocardial Perfusion Database

Quantitative 82Rb PET/CT: Development and Validation of Myocardial Perfusion Database

Initial Characterization of an ¹⁸F-Labeled Myocardial Perfusion Tracer

Imaging Techniques in Nuclear Cardiology for the Assessment of Myocardial Viability

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Detection of coronary artery disease with positron emission tomography and rubidium 82

Cited by 56 publications

References 14 publications

Quantitative 82Rb PET/CT: Development and Validation of Myocardial Perfusion Database

Quantitative 82Rb PET/CT: Development and Validation of Myocardial Perfusion Database

Initial Characterization of an 18F-Labeled Myocardial Perfusion Tracer

Imaging Techniques in Nuclear Cardiology for the Assessment of Myocardial Viability

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Initial Characterization of an ¹⁸F-Labeled Myocardial Perfusion Tracer