Quantification of myocardial blood flow will reform the detection of CAD

Knuuti, Juhani; Kajander, Sami; Mäki, Maija; Ukkonen, Heikki

doi:10.1007/s12350-009-9101-1

Cited by 78 publications

(61 citation statements)

References 24 publications

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“…These relationships are demonstrated in Figure 6. 22 Another limitation is the lack of ECG gating in our approach. Gated images provide information about wall motion, and this information could improve the accuracy of relative analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value of Absolute Quantification of Myocardial Perfusion With ¹⁵ O-Water in Coronary Artery Disease

Kajander

Joutsiniemi

Saraste

et al. 2011

Circ: Cardiovascular Imaging

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169

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Background-The standard interpretation of perfusion imaging is based on the assessment of relative perfusion distribution. The limitations of that approach have been recognized in patients with multivessel disease and endothelial dysfunction. To date, however, no large clinical studies have investigated the value of measuring quantitative blood flow and compared that with relative uptake. Methods and Results-One hundred four patients with moderate (30%-70%) pretest likelihood of coronary artery disease (CAD) underwent PET imaging during adenosine stress using 15 O-water and dynamic imaging. Absolute myocardial blood flow was calculated from which both standard relative myocardial perfusion images and images scaled to a known absolute scale were produced. The patients and the regions then were classified as normal or abnormal and compared against the reference of conventional angiography with fractional flow reserve. In patient-based analysis, the positive predictive value, negative predictive value, and accuracy of absolute perfusion in the detection of any obstructive CAD were 86%, 97%, and 92%, respectively, with absolute quantification. The corresponding values with relative analysis were 61%, 83%, and 73%, respectively. In region-based analysis, the receiver operating characteristic curves confirmed that the absolute quantification was superior to relative assessment. In particular, the specificity and positive predictive value were low using just relative differences in flow. Only 9 of 24 patients with 3-vessel disease were correctly assessed using relative analysis. Conclusions-The measurement of myocardial blood flow in absolute terms has a significant impact on the interpretation of myocardial perfusion. As expected, multivessel disease is more accurately detected. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00627172. (Circ Cardiovasc Imaging. 2011;4:678-684.)

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Section: Discussionmentioning

confidence: 99%

Clinical Value of Absolute Quantification of Myocardial Perfusion With ¹⁵ O-Water in Coronary Artery Disease

Kajander

Joutsiniemi

Saraste

et al. 2011

Circ: Cardiovascular Imaging

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169

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“…Several recent studies have stressed the added value of combined quantitative myocardial blood flow (MBF) and coronary flow reserve (CFR) measurements over qualitative myocardial perfusion imaging (1)(2)(3)(4)(5). The introduction of integrated PET/CT systems, equipped with a CT scanner of at least 64 slices, allows for measurements of calcium score, MBF at rest and MBF during pharmacologic stress, and CT coronary angiography in a single scan session, increasing the diagnostic efficiency and patient comfort (1,(5)(6)(7).…”

mentioning

confidence: 99%

“…The introduction of integrated PET/CT systems, equipped with a CT scanner of at least 64 slices, allows for measurements of calcium score, MBF at rest and MBF during pharmacologic stress, and CT coronary angiography in a single scan session, increasing the diagnostic efficiency and patient comfort (1,(5)(6)(7). The necessity of an on-site cyclotron for the production of 15 O has been an obstacle for its introduction into routine clinical practice; however, because water is freely diffusible and has no metabolic interactions in tissue, PET using 15 O-water is considered to be the gold standard for noninvasive quantitative measurements of MBF (3,5).…”

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confidence: 99%

Low-Dose Quantitative Myocardial Blood Flow Imaging Using ¹⁵O-Water and PET Without Attenuation Correction

Lubberink¹,

Harms²,

Halbmeijer³

et al. 2010

J Nucl Med

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Misalignment between PET and low-dose CT (LD-CT) can cause severe artifacts in cardiac PET/CT because of attenuationcorrection errors, even when using slow or cine LD-CT. Myocardial blood flow (MBF), as measured by 15 O-water, can be determined from the rate of 15 O-water washout from myocardial tissue, which is independent of tissue attenuation. The purpose of the present study was to assess the accuracy of these MBF measurements in the absence of attenuation correction. Methods: Twenty-five patients referred for evaluation of myocardial perfusion underwent 6-min rest and adenosine stress PET scans after the administration of 370 MBq of 15 O-water; both scans were followed by slow LD-CT. Data were acquired on a PET/CT scanner and reconstructed by a 3-dimensional row-action maximum likelihood algorithm both with (CTAC) and without (NAC) attenuation correction. An ascending aorta volume of interest was used as input function. MBF and coronary flow reserve (CFR) were calculated for 17 myocardial segments using nonlinear regression of the standard single-tissuecompartment model with corrections for left and right ventricular spillover and perfusable tissue fraction. Results: High correlation (r 2 5 0.99 and 0.97, with slopes of 0.96 and 0.91 for rest and stress, respectively) and excellent agreement (intraclass correlation coefficient [ICC], 1.00 and 0.98) between NAC-and CTACbased MBF values were found. Absolute rest and stress MBF values were 3% and 8%, respectively, lower for NAC scans. The correlation coefficient between all NAC and CTAC CFR values was 0.95 (ICC, 0.95; slope, 0.92) and 0.97 (ICC, 0.99; slope, 1.01) when only CFR values below 2 were considered. Deviations between CTAC and NAC values were smallest for basal segments and increased toward the apex. Conclusion: MBF and CFR can be measured accurately using 15 O-water and PET without correcting for attenuation, reducing the effective dose to the patient to 0.8 mSv for a complete rest-stress protocol. This dose is an order of magnitude lower than typical values for 82 Rb, 99m Tc-methoxyisobutylisonitrile, or CT perfusion scans.

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“…The use of absolute quantification of myocardial blood flow enables the detection of early endothelial and vascular changes affecting flow before overt disease develops as well as detecting multivessel or left main stem coronary artery disease in situations where there is balanced flow reduction to all coronary arteries [47].…”

Section: Clinical Impactmentioning

confidence: 99%

Myocardial perfusion scintigraphy: past, present and future

Notghi

Low²

2011

BJR

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ABSTRACT. During the last two decades, radionuclide myocardial perfusion scintigraphy (MPS) has become established as the main functional cardiac imaging technique for the assessment of ischaemic heart disease (IHD). Despite a growing number of alternative functional imaging techniques, MPS still remains the most widely used technique, with a wealth of literature supporting its usefulness in assessing IHD and predicting prognosis. The technique itself has evolved, making it more reliable and robust, with additional ventricular functional information that further defines the prognosis in these patients. With the advent of hybrid single photon emission with CT and positron emission tomography with CT cameras together with the development of new camera technology that enables faster images with less radiation and better resolution, MPS will remain an essential part of IHD investigation. There are new promising radiopharmacological developments and applications such as radiolabelled fatty acids and metaiodobenzylguanidine. These will widen the scope of nuclear medicine imaging to include patients with cardiac failure and acute chest pain presenting to accident and emergency departments. Nuclear medicine cardiac investigations will continue to have an essential role in the diagnosis, stratification and prognosis of patients with cardiac disease, complementing the new developing cardiac modalities such as CT coronary angiography and MRI.

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Quantification of myocardial blood flow will reform the detection of CAD

Cited by 78 publications

References 24 publications

Clinical Value of Absolute Quantification of Myocardial Perfusion With ¹⁵ O-Water in Coronary Artery Disease

Clinical Value of Absolute Quantification of Myocardial Perfusion With ¹⁵ O-Water in Coronary Artery Disease

Low-Dose Quantitative Myocardial Blood Flow Imaging Using ¹⁵O-Water and PET Without Attenuation Correction

Myocardial perfusion scintigraphy: past, present and future

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Quantification of myocardial blood flow will reform the detection of CAD

Cited by 78 publications

References 24 publications

Clinical Value of Absolute Quantification of Myocardial Perfusion With 15 O-Water in Coronary Artery Disease

Clinical Value of Absolute Quantification of Myocardial Perfusion With 15 O-Water in Coronary Artery Disease

Low-Dose Quantitative Myocardial Blood Flow Imaging Using 15O-Water and PET Without Attenuation Correction

Myocardial perfusion scintigraphy: past, present and future

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Product

Resources

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Clinical Value of Absolute Quantification of Myocardial Perfusion With ¹⁵ O-Water in Coronary Artery Disease

Clinical Value of Absolute Quantification of Myocardial Perfusion With ¹⁵ O-Water in Coronary Artery Disease

Low-Dose Quantitative Myocardial Blood Flow Imaging Using ¹⁵O-Water and PET Without Attenuation Correction