Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
European Journal of Nuclear Medicine and Molecular Imaging
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 8/2016

18.03.2016 | Original Article

Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina

verfasst von: Valentina Berti, Roberto Sciagrà, Danilo Neglia, Mikko Pietilä, Arthur J. Scholte, Stephan Nekolla, François Rouzet, Alberto Pupi, Juhani Knuuti

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 8/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The goal of this study is to determine the technical accuracy of segmental perfusion parameters assessed with quantitative cardiac PET imaging in the evaluation of coronary artery disease (CAD) in patients with stable angina.

Methods

A cohort of patients who participated in the EVINCI protocol underwent an evaluation of coronary anatomy by invasive coronary angiography (ICA) and/or coronary computed tomography angiography (CCTA) and PET myocardial perfusion imaging with H2 15O, 13NH3 or 82Rb. PET studies were analyzed by two independent observers blinded to clinical and instrumental data, and classified as positive or negative for significant CAD using only segmental perfusion measurements and cut-off values from literature.

Results

On a per-patient basis, the overall inter-observer agreement on PET results was 90 % (kappa = 0.79), indicating substantial agreement. On a per-vessel basis, the inter-observer agreement on PET results was 88 % (kappa = 0.74) in the RCA territory, 94 % (kappa = 0.84) in the LAD territory and 94 % (kappa = 0.85) in the LCX territory.
Segmental PET measurements correctly identified 85 % of the patients, resulting in a global sensitivity of 86 %, a specificity of 84 %, a positive predictive value (PPV) of 69 % and a negative predictive value (NPV) of 93 %.
In vessel-based analyses, quantitative perfusion parameters had a sensitivity, specificity, PPV and NPV of 92 %, 82 %, 42 % and 99 %, respectively, for the detection of significant coronary stenoses in all major coronary arteries.

Conclusions

The assessment of absolute myocardial perfusion parameters measured at a segment level lead to reliable and accurate identification of patients with significant coronary stenosis at ICA and/or CCTA.
Literatur
1.
deKemp RA, Ruddy TD, Hewitt T, Dalipaj MM, Beanlands R. Detection of serial changes in absolute myocardial perfusion with Rb-82 PET. J Nucl Med. 2000;41:1426–35.PubMed
2.
Kuhle WG, Porenta G, Huang SC, Buxton D, Gambhir SS, Hansen H, et al. Quantification of regional myocardial blood-flow using N-13 ammonia and reoriented dynamic positron emission tomographic imaging. Circulation. 1992;86:1004–17.CrossRefPubMed
3.
DiCarli M, Czernin J, Hoh CK, Gerbaudo VH, Brunken RC, Huang SC, et al. Relation among stenosis severity, myocardial blood-flow, and flow reserve in patients with coronary-artery disease. Circulation. 1995;91:1944–51.CrossRef
4.
Ahn JY, Lee DS, Lee JS, Kim SK, Cheon GJ, Yeo JS, et al. Quantification of regional myocardial blood flow using dynamic H2(15)O PET and factor analysis. J Nucl Med. 2001;42:782–7.PubMed
5.
Fiechter M, Ghadri JR, Gebhard C, Fuchs TA, Pazhenkottil AP, Nkoulou RN, et al. Diagnostic value of 13N-ammonia myocardial perfusion PET: added value of myocardial flow reserve. J Nucl Med. 2012;53:1230–4.CrossRefPubMed
6.
Schindler TH, Schelbert HR, Quercioli A, Dilsizian V. Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging. 2010;3:623–40.CrossRefPubMed
7.
Schindler TH, Quercioli A, Valenta I, Ambrosio G, Wahl RL, Dilsizian V. Quantitative assessment of myocardial blood flow—clinical and research applications. Semin Nucl Med. 2014;44:274–93.CrossRefPubMed
8.
Herzog BA, Husmann L, Valenta I, Gaemperli O, Siegrist PT, Tay FM, 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.CrossRefPubMed
9.
10.
Neglia D, Michelassi C, Trivieri MG, Sambuceti G, Giorgetti A, Pratali L, et al. Prognostic role of myocardial blood flow impairment in idiopathic left ventricular dysfunction. Circulation. 2002;105:186–93.CrossRefPubMed
11.
Saraste A, Kajander S, Han C, Nesterov SV, Knuuti J. PET: is myocardial flow quantification a clinical reality? J Nucl Cardiol. 2012;19:1044–59.CrossRefPubMed
12.
Nesterov SV, Deshayes E, Sciagrà R, Settimo L, Declerck JM, Pan X-B, et al. Quantification of myocardial blood flow in absolute terms using 82Rb PET imaging - results of RUBY-10 study. JACC Cardiovasc Imaging. 2014;7:1119–27.CrossRefPubMedPubMedCentral
13.
Yoshinaga K, Katoh C, Manabe O, Klein R, Naya M, Sakakibara M, et al. Incremental diagnostic value of regional myocardial blood flow quantification over relative perfusion imaging with generator-produced rubidium-82 PET. Circ J. 2011;75:2628–34.CrossRefPubMed
14.
Kajander SA, Joutsiniemi E, Saraste M, Pietila M, Ukkonen H, Saraste A, et al. Clinical value of absolute quantification of myocardial perfusion with 15O-water in coronary artery disease. Circ Cardiovasc Imaging. 2011;4:678–84.CrossRefPubMed
15.
Liga R, Marini C, Coceani M, Filidei E, Schlueter M, Bianchi M, et al. Structural abnormalities of the coronary arterial wall--in addition to luminal narrowing--affect myocardial blood flow reserve. J Nucl Med. 2011;52:1704–12.CrossRefPubMed
16.
Parkash R, deKemp RA, Ruddy TD, Kitsikis A, Beauschene L, Williams K, et al. Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease. J Nucl Cardiol. 2004;11:440–9.CrossRefPubMed
17.
Hajjiri MM, Leavitt MB, Zheng H, Spooner AE, Fischman AJ, Gewirtz H. Comparison of positron emission tomography measurement of adenosine-stimulated absolute myocardial blood flow versus relative myocardial tracer content for physiological assessment of coronary artery stenosis severity and location. JACC Cardiovasc Imaging. 2009;2:751–8.CrossRefPubMed
18.
Kaufmann PA, Gnecchi-Ruscone T, Yap JT, Rimoldi O, Camici PG. Assessment of the reproducibility of baseline and hyperemic myocardial blood flow measurements with 15O-labeled water and PET. J Nucl Med. 1999;40:1848–56.PubMed
19.
El Fakhri G, Kardan A, Sitek A, Dorbala S, Abi-Hatem N, Lahoud Y, et al. Reproducibility and accuracy of quantitative myocardial blood flow assessment with 82Rb PET: comparison with 13N-ammonia PET. J Nucl Med. 2009;50:1062–71.CrossRefPubMedPubMedCentral
20.
Schindler TH, Zhang X-L, Prior JO, Cadenas J, Dahlbom M, Sayre J, et al. Assessment of intra- and interobserver reproducibility of rest and cold pressor test-stimulated myocardial blood flow with 13N-ammonia and PET. Eur J Nucl Med Mol Imaging. 2007;34:1178–88.CrossRefPubMed
21.
Harms HJ, Nesterov SV, Han C, Danad I, Leonora R, Raijmakers PG, et al. Comparison of clinical non-commercial tools for automated quantification of myocardial blood flow using oxygen-15-labelled water PET/CT. Eur Heart J Cardiovasc Imaging. 2014;15:431–41.CrossRefPubMed
22.
Slomka PJ, Alexanderson E, Jacome R, Jimenez M, Romero E, Meave A, 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. 2012;53:171–81.CrossRefPubMed
23.
Nitzsche EU, Choi Y, Czernin J, Hoh CK, Huang SC, Schelbert HR. Noninvasive quantification of myocardial blood flow in humans. A direct comparison of the [13N]ammonia and the [15O]water techniques. Circulation. 1996;93:2000–6.CrossRefPubMed
24.
Prior JO, Allenbach G, Valenta I, Kosinski M, Burger C, Verdun FR, 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.CrossRefPubMedPubMedCentral
25.
Kajander S, Joutsiniemi E, Saraste M, Pietila M, Ukkonen H, Saraste A, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation. 2010;122:603–13.CrossRefPubMed
26.
Danad I, Uusitalo V, Kero T, Saraste A, Raijmakers PG, Lammertsma AA, et al. Quantitative assessment ofmyocardial perfusion in the detection of significant coronary artery disease. J Am Coll Cardiol. 2014;64:1464–75.CrossRefPubMed
27.
Neglia D, Rovai D, Caselli C, Pietilä M, Teresinska A, Aguadé-Bruix S, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging. 2015. doi:10.​1161/​CIRCIMAGING.​114.​002179.PubMed
28.
Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005;32:855–97.CrossRefPubMed
29.
Hermansen F, Rosen SD, Fath-Ordoubadi F, Kooner JS, Clark JC, Camici PG, et al. Measurement of myocardial blood flow with oxygen-15 labelled water: comparison of different administration protocols. Eur J Nucl Med Mol Imaging. 1998;25:751–9.CrossRef
30.
DeGrado T, Hanson M, Turkington T, DeLong D, Brezinski D, Vallee J, et al. Estimation of myocardial blood flow for longitudinal studies with 13N-labeled ammonia and positron emission tomography1. J Nucl Cardiol. 1996;3:494–507.CrossRefPubMed
31.
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.CrossRefPubMed
32.
Cerqueira MD. 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;105:539–42.CrossRefPubMed
33.
Anagnostopoulos C, Almonacid A, El Fakhri G, Curillova Z, Sitek A, Roughton M, et al. Quantitative relationship between coronary vasodilator reserve assessed by 82Rb PET imaging and coronary artery stenosis severity. Eur J Nucl Med Mol Imaging. 2008;35:1593–601.CrossRefPubMedPubMedCentral
34.
Johnson NP, Gould KL. Physiological basis for Angina and ST-segment change. JACC Cardiovasc Imaging. 2011;4:990–8.CrossRefPubMed
35.
Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, et al. Noninvasive coronary artery Imaging - Magnetic resonance angiography and multidetector computed tomography angiography - A scientific statement from the American Heart Association Committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation. 2008;118:586–606.CrossRefPubMed
36.
Chow BJW, Abraham A, Wells GA, Chen L, Ruddy TD, Yam Y, et al. Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography. Circ Cardiovasc Imaging. 2009;2:16–23.CrossRefPubMed
37.
Sciagrà R. Quantitative cardiac positron emission tomography: the time is coming! Scientifica. 2012;2012:1–16.CrossRef
38.
Danad I, Raijmakers PG, Appelman YE, Harms HJ, de Haan S, van den Oever MLP, et al. Hybrid imaging using quantitative H215O PET and CT-based coronary angiography for the detection of coronary artery disease. J Nucl Med. 2012;54:55–63.CrossRefPubMed
39.
Neglia D, L'Abbate A. Myocardial perfusion reserve in ischemic heart disease. J Nucl Med. 2009;50:175–7.CrossRefPubMed
40.
Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, et al. Anatomic versus physiologic assessment of coronary artery disease. J Am Coll Cardiol. 2013;62:1639–53.CrossRefPubMed
41.
Johnson NP, Kirkeeide RL, Gould KL. Is discordance of coronary flow reserve and fractional flow reserve due to methodology or clinically relevant coronary pathophysiology? JACC Cardiovasc Imaging. 2012;5:193–202.CrossRefPubMed
42.
Reddy KG, Nair RN, Sheehan HM, Hodgson JM. Evidence that selective endothelial dysfunction may occur in the absence of angiographic or ultrasound atherosclerosis in patients with risk factors for atherosclerosis. J Am Coll Cardiol. 1994;23:833–43.CrossRefPubMed
43.
Czernin J, Muller P, Chan S, Brunken RC, Porenta G, Krivokapich J, et al. Influence of age and hemodynamics on myocardial blood-flow and flow reserve. Circulation. 1993;88:62–9.CrossRefPubMed
44.
Javadi MS, Lautamäki R, Merrill J, Voicu C, Epley W, McBride G, et al. Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: a hybrid PET/CT analysis. J Nucl Med. 2010;51:198–203.CrossRefPubMed
Metadaten
Titel
Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina
verfasst von
Valentina Berti
Roberto Sciagrà
Danilo Neglia
Mikko Pietilä
Arthur J. Scholte
Stephan Nekolla
François Rouzet
Alberto Pupi
Juhani Knuuti
Publikationsdatum
18.03.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 8/2016
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-016-3362-0

Weitere Artikel der Ausgabe 8/2016

European Journal of Nuclear Medicine and Molecular Imaging 8/2016 Zur Ausgabe

Original Article

Intratumoral heterogeneity of 18F-FDG uptake predicts survival in patients with pancreatic ductal adenocarcinoma

Original Article

Long-term evaluation of the effect of hypofractionated high-energy proton treatment of benign meningiomas by means of 11C-l-methionine positron emission tomography

Original Article

Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases

Erratum

Erratum to: Quantitative assessment of atherosclerotic plaques on 18F-FDG PET/MRI: comparison with a PET/CT hybrid system

Image of the Month

Recurrent prosthetic mitral valve infective endocarditis and perivalvular abscess: first description by PET/CT angiography

Original Article

Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with 68Ga-PSMA-HBED-CC than with 18F-Fluoroethylcholine PET/CT