nach oben

Erschienen in:

16.07.2020 | ORIGINAL ARTICLE

Quantitative myocardial perfusion ⁸²Rb-PET assessed by hybrid PET/coronary-CT: Normal values and diagnostic performance

verfasst von: Martin T. Freitag, MD, Jens Bremerich, MD, Damian Wild, MD, Philip Haaf, MD, Michael J. Zellweger, MD, Federico Caobelli, MD, FEBNM

Erschienen in: Journal of Nuclear Cardiology | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

We aimed to assess normal values for quantified myocardial blood flow (MBF) on a hybrid PET/coronary-CT scanner and to test their diagnostic performance in patients with suspected CAD.

Materials and Methods

Patients underwent ⁸²Rb-PET/CT and integrated CT-based coronary angiography (CCTA) and were classified as normal (no stenosis), with non-obstructive stenosis (< 50%) and with CAD (≥ 50%). Global and regional stress MBF (sMBF), rest MBF and myocardial flow reserve (MFR) were calculated. Ischemia was defined as SDS ≥ 2, severe ischemia as SDS ≥ 7.

Results

357 consecutive patients were included. Global sMBF and MFR were higher in normal patients than in patients with CAD (3.61 ± 0.71 vs 3.04 ± 0.77, P < 0.0001; 3.08 ± 0.84 vs 2.68 ± 0.79, P = 0.0001), but not different compared to patients with non-obstructive stenosis (3.61 ± 0.71 vs 3.43 ± 0.69, P = 0.052; 3.08 ± 0.84 vs 2.99 ± 0.82, P = 0.45). sMBF yielded superior accuracy over MFR in identifying both ischemia (AUC 0.74 vs 0.62, P = 0.003) and severe ischemia (AUC 0.88 vs 0.78, P = 0.012). Optimal threshold for global sMBF to rule out myocardial ischemia was 3.5 mL g⁻¹ min⁻¹.

Conclusions

Normal quantitative values are provided. Global sMBF provided higher diagnostic accuracy than MFR. Using sMBF-threshold of 3.5 mL·g⁻¹·min⁻¹ on ⁸²Rb-PET/CT yielded similar NPV (96%) as CCTA to rule out CAD. Hence, resting scan could be omitted in patients with sMBF values above reference.

Nur mit Berechtigung zugänglich

Flotats A, Bravo PE, Fukushima K, Chaudhry MA, Merrill J, Bengel FM. 82Rb PET myocardial perfusion imaging is superior to 99mTc-labelled agent SPECT in patients with known or suspected coronary artery disease. Eur J Nucl Med Mol Imaging. 2012;39:1233-9.CrossRef

Bengel FM, Higuchi T, Javadi MS, Lautamäki R. Cardiac positron emission tomography. J Am Coll Cardiol. 2009;54:1-15.CrossRef

Sunderland JJ, Pan X-B, Declerck J, Menda Y. Dependency of cardiac rubidium-82 imaging quantitative measures on age, gender, vascular territory, and software in a cardiovascular normal population. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2015;22:72-84.

Prior JO, Allenbach G, Valenta I, et al. Quantification of myocardial blood flow with 82Rb positron emission tomography: Clinical validation with 15O-water. Eur J Nucl Med Mol Imaging. 2012;39:1037-47.CrossRef

Danad I, Uusitalo V, Kero T, et al. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease. J Am Coll Cardiol. 2014;64:1464-75.CrossRef

Arbab-Zadeh A, Di Carli MF, Cerci R, et al. Accuracy of computed tomographic angiography and single-photon emission computed tomography-acquired myocardial perfusion imaging for the diagnosis of coronary artery disease. Circ Cardiovasc Imaging. 2015;8:e003533.CrossRef

Tahari AK, Lee A, Rajaram M, et al. Absolute myocardial flow quantification with (82)Rb PET/CT: Comparison of different software packages and methods. Eur J Nucl Med Mol Imaging. 2014;41:126-35.CrossRef

Fukushima K, Javadi MS, Higuchi T, et al. Prediction of short-term cardiovascular events using quantification of global myocardial flow reserve in patients referred for clinical 82Rb PET perfusion imaging. J Nucl Med Off Publ Soc Nucl Med. 2011;52:726-32.

Ziadi MC, Dekemp RA, Williams KA, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol. 2011;58:740-8.CrossRef

10.

Herzog BA, Husmann L, Valenta I, et al. Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography added value of coronary flow reserve. J Am Coll Cardiol. 2009;54:150-6.CrossRef

11.

Stuijfzand WJ, Uusitalo V, Kero T, et al. Relative flow reserve derived from quantitative perfusion imaging may not outperform stress myocardial blood flow for identification of hemodynamically significant coronary artery disease. Circ Cardiovasc Imaging. 2015. https://doi.org/10.1161/CIRCIMAGING.114.002400.CrossRefPubMed

12.

Lortie M, Beanlands RSB, Yoshinaga K, Klein R, DaSilva JN, deKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging. 2007;34:1765-74.CrossRef

13.

Czernin J, Muller P, Chan S, et al. Influence of age and hemodynamics on myocardial blood flow and flow reserve. Circulation. 1993;88:62-9.CrossRef

14.

Hansen CL, Goldstein RA, Akinboboye OO, et al. Myocardial perfusion and function: Single photon emission computed tomography. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2007;14:e39-60.

15.

American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging, Cerqueira MD, Weissman NJ, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105:539-542.

16.

Knuuti J, Kajander S, Mäki M, Ukkonen H. Quantification of myocardial blood flow will reform the detection of CAD. J Nucl Cardiol. 2009;16:497-506.CrossRef

17.

Caobelli F. Anatomical and functional assessment of coronary artery disease in patients with stable angina: Which is the gold standard? J Nucl Cardiol. 2019;9:S26-35.

18.

Tonino PA, Fearon WF, De Bruyne B, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study: fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55:2816-21.

19.

Gaur S, Øvrehus KA, Dey D, et al. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions. Eur Heart J. 2016;37:1220-7.

20.

Toth G, Hamilos M, Pyxaras S, et al. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014;35:2831-8.

21.

Hoffmann U, Bamberg F, Chae CU, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain. J Am Coll Cardiol. 2009;53:1642-50.CrossRef

22.

Caobelli F. Left ventricular segmentation in myocardial perfusion positron emission tomography: Tailor-made or prêt-à-porter? Eur Heart J Cardiovasc Imaging. 2019;20:502-3.CrossRef

23.

Slomka PJ, Alexanderson E, Jácome R, et al. Comparison of clinical tools for measurements of regional stress and rest myocardial blood flow assessed with 13N-ammonia PET/CT. J Nucl Med Off Publ Soc Nucl Med. 2012;53:171-81.

24.

Nesterov SV, Deshayes E, Sciagrà R, et al. Quantification of myocardial blood flow in absolute terms using 82Rb PET imaging. JACC Cardiovasc Imaging. 2014;7:1119-27.CrossRef

Titel: Quantitative myocardial perfusion 82Rb-PET assessed by hybrid PET/coronary-CT: Normal values and diagnostic performance
verfasst von: Martin T. Freitag, MD
Jens Bremerich, MD
Damian Wild, MD
Philip Haaf, MD
Michael J. Zellweger, MD
Federico Caobelli, MD, FEBNM
Publikationsdatum: 16.07.2020
Verlag: Springer International Publishing
Erschienen in: Journal of Nuclear Cardiology / Ausgabe 2/2022
Print ISSN: 1071-3581
Elektronische ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-020-02264-4

Neu im Fachgebiet Kardiologie

Das Risiko für Vorhofflimmern in der Bevölkerung steigt

02.05.2024 Vorhofflimmern Nachrichten

Das Risiko, im Lauf des Lebens an Vorhofflimmern zu erkranken, ist in den vergangenen 20 Jahren gestiegen: Laut dänischen Zahlen wird es drei von zehn Personen treffen. Das hat Folgen weit über die Schlaganfallgefährdung hinaus.

VHF-Ablation nützt wohl nur bei reduzierter Auswurfleistung

02.05.2024 Ablationstherapie Nachrichten

Ob die Katheterablation von Vorhofflimmern bei Patienten mit Herzinsuffizienz die Komplikationsraten senkt, scheint davon abzuhängen, ob die Auswurfleistung erhalten ist oder nicht. Das legen die Ergebnisse einer Metaanalyse nahe.

Weniger Extremitätenischämien mit dualer Plättchenhemmung

02.05.2024 Thrombozytenaggregationshemmer Nachrichten

Eine Behandlung mit Ticagrelor zusätzlich zu ASS kann das Risiko für Revaskularisierungen und Amputationen von Extremitäten bei Diabetikern mit stabiler KHK deutlich reduzieren, vor allem für solche mit PAVK. Dafür spricht eine Auswertung der Interventionsstudie THEMIS.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Quantitative myocardial perfusion ⁸²Rb-PET assessed by hybrid PET/coronary-CT: Normal values and diagnostic performance