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05.08.2019 | Original Article | Ausgabe 12/2019

European Journal of Nuclear Medicine and Molecular Imaging 12/2019

Triple-gated motion and blood pool clearance corrections improve reproducibility of coronary 18F-NaF PET

European Journal of Nuclear Medicine and Molecular Imaging > Ausgabe 12/2019
Martin Lyngby Lassen, Jacek Kwiecinski, Damini Dey, Sebastien Cadet, Guido Germano, Daniel S. Berman, Philip D. Adamson, Alastair J. Moss, Marc R. Dweck, David E. Newby, Piotr J. Slomka
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00259-019-04437-x) contains supplementary material, which is available to authorized users.
This article is part of the Topical Collection on Cardiology

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To improve the test–retest reproducibility of coronary plaque 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) uptake measurements.


We recruited 20 patients with coronary artery disease who underwent repeated hybrid PET/CT angiography (CTA) imaging within 3 weeks. All patients had 30-min PET acquisition and CTA during a single imaging session. Five PET image-sets with progressive motion correction were reconstructed: (i) a static dataset (no-MC), (ii) end-diastolic PET (standard), (iii) cardiac motion corrected (MC), (iv) combined cardiac and gross patient motion corrected (2 × MC) and, (v) cardiorespiratory and gross patient motion corrected (3 × MC). In addition to motion correction, all datasets were corrected for variations in the background activities which are introduced by variations in the injection-to-scan delays (background blood pool clearance correction, BC). Test–retest reproducibility of PET target-to-background ratio (TBR) was assessed by Bland–Altman analysis and coefficient of reproducibility.


A total of 47 unique coronary lesions were identified on CTA. Motion correction in combination with BC improved the PET TBR test–retest reproducibility for all lesions (coefficient of reproducibility: standard = 0.437, no-MC = 0.345 (27% improvement), standard + BC = 0.365 (20% improvement), no-MC + BC = 0.341 (27% improvement), MC + BC = 0.288 (52% improvement), 2 × MC + BC = 0.278 (57% improvement) and 3 × C + BC = 0.254 (72% improvement), all p < 0.001). Importantly, in a sub-analysis of 18F-NaF-avid lesions with gross patient motion > 10 mm following corrections, reproducibility was improved by 133% (coefficient of reproducibility: standard = 0.745, 3 × MC = 0.320).


Joint corrections for cardiac, respiratory, and gross patient motion in combination with background blood pool corrections markedly improve test–retest reproducibility of coronary 18F-NaF PET.

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