Quantification of myocardial blood flow with 82Rb positron emission tomography: clinical validation with 15O-waterReport as inadecuate




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European Journal of Nuclear Medicine and Molecular Imaging

, Volume 39, Issue 6, pp 1037–1047

First Online: 08 March 2012Received: 28 September 2011Accepted: 01 February 2012

Abstract

PurposeQuantification of myocardial blood flow MBF with generator-produced Rb is an attractive alternative for centres without an on-site cyclotron. Our aim was to validate Rb-measured MBF in relation to that measured using O-water, as a tracer 100% of which can be extracted from the circulation even at high flow rates, in healthy control subject and patients with mild coronary artery disease CAD.

MethodsMBF was measured at rest and during adenosine-induced hyperaemia with Rb and O-water PET in 33 participants 22 control subjects, aged 30 ± 13 years; 11 CAD patients without transmural infarction, aged 60 ± 13 years. A one-tissue compartment Rb model with ventricular spillover correction was used. The Rb flow-dependent extraction rate was derived from O-water measurements in a subset of 11 control subjects. Myocardial flow reserve MFR was defined as the hyperaemic-rest MBF. Pearson’s correlation r, Bland-Altman 95% limits of agreement LoA, and Lin’s concordance correlation ρc measuring both precision and accuracy were used.

ResultsOver the entire MBF range 0.66–4.7 ml-min-g, concordance was excellent for MBF r = 0.90, Rb–O-water mean difference ± SD = 0.04 ± 0.66 ml-min-g, LoA = −1.26 to 1.33 ml-min-g, ρc = 0.88 and MFR range 1.79–5.81, r = 0.83, mean difference = 0.14 ± 0.58, LoA = −0.99 to 1.28, ρc = 0.82. Hyperaemic MBF was reduced in CAD patients compared with the subset of 11 control subjects 2.53 ± 0.74 vs. 3.62 ± 0.68 ml-min-g, p = 0.002, for O-water; 2.53 ± 1.01 vs. 3.82 ± 1.21 ml-min-g, p = 0.013, for Rb and this was paralleled by a lower MFR 2.65 ± 0.62 vs. 3.79 ± 0.98, p = 0.004, for O-water; 2.85 ± 0.91 vs. 3.88 ± 0.91, p = 0.012, for Rb. Myocardial perfusion was homogeneous in 1,114 of 1,122 segments 99.3% and there were no differences in MBF among the coronary artery territories p > 0.31.

ConclusionQuantification of MBF with Rb with a newly derived correction for the nonlinear extraction function was validated against MBF measured using O-water in control subjects and patients with mild CAD, where it was found to be accurate at high flow rates. Rb-derived MBF estimates seem robust for clinical research, advancing a step further towards its implementation in clinical routine.

KeywordsMyocardial blood flow Positron emission tomography Rubidium-82 Healthy subjects Coronary artery disease  Download fulltext PDF



Author: John O. Prior - Gilles Allenbach - Ines Valenta - Marek Kosinski - Cyrill Burger - Francis R. Verdun - Angelika Bischof D

Source: https://link.springer.com/







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