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29.11.2018 | Original Article

Analytical quantification of aortic valve 18F-sodium fluoride PET uptake

Journal of Nuclear Cardiology
MD, MSc Daniele Massera, MD Mhairi K. Doris, MSc Sebastien Cadet, MD Jacek Kwiecinski, MD, PhD Tania A. Pawade, MD Frederique E. C. M. Peeters, PhD Damini Dey, MD, PhD David E. Newby, MD, PhD Marc R. Dweck, PhD Piotr J. Slomka
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The online version of this article (https://​doi.​org/​10.​1007/​s12350-018-01542-6) contains supplementary material, which is available to authorized users.
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This research was supported in part by Grant R01HL135557 from the National Heart, Lung, and Blood Institute/National Institute of Health (NHLBI/NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. D. M. was supported by The Glorney-Raisbeck Fellowship Program, Corlette Glorney Foundation, and The New York Academy of Medicine. The study was also supported by a Grant (“Cardiac Imaging Research Initiative”) from the Miriam & Sheldon G. Adelson Medical Research Foundation. David Newby (CH/09/002, RE/13/3/30183), Marc Dweck (FS/14/78), and Mhairi Doris (FS/17/79/33226) are supported by the British Heart Foundation. David Newby is also the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Marc Dweck is the recipient of the Sir Jules Thorn Award for biomedical research (15/JTA).



Challenges to cardiac PET-CT include patient motion, prolonged image acquisition and a reduction of counts due to gating. We compared two analytical tools, FusionQuant and OsiriX, for quantification of gated cardiac 18F-sodium fluoride (18F-fluoride) PET-CT imaging.


Twenty-seven patients with aortic stenosis were included, 15 of whom underwent repeated imaging 4 weeks apart. Agreement between analytical tools and scan-rescan reproducibility was determined using the Bland–Altman method and Lin’s concordance correlation coefficients (CCC).


Image analysis was faster with FusionQuant [median time (IQR) 7:10 (6:40-8:20) minutes] compared with OsiriX [8:30 (8:00-10:10) minutes, p = .002]. Agreement of uptake measurements between programs was excellent, CCC = 0.972 (95% CI 0.949-0.995) for mean tissue-to-background ratio (TBRmean) and 0.981 (95% CI 0.965-0.997) for maximum tissue-to-background ratio (TBRmax). Mean noise decreased from 11.7% in the diastolic gate to 6.7% in motion-corrected images (p = .002); SNR increased from 25.41 to 41.13 (p = .0001). Aortic valve scan-rescan reproducibility for TBRmax was improved with FusionQuant using motion correction compared to OsiriX (error ± 36% vs ± 13%, p < .001) while reproducibility for TBRmean was similar (± 10% vs ± 8% p = .252).


18F-fluoride PET quantification with FusionQuant and OsiriX is comparable. FusionQuant with motion correction offers advantages with respect to analysis time and reproducibility of TBRmax values.

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