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29.10.2018 | Original Article

Vessel-specific quantification of absolute myocardial blood flow, myocardial flow reserve and relative flow reserve by means of fused dynamic 13NH3 PET and CCTA: Ranges in a low-risk population and abnormality criteria

Journal of Nuclear Cardiology
PhD Marina Piccinelli, MD Sang-Geon Cho, PhD Ernest V. Garcia, MD Erick Alexanderson, MD, PhD Joo Myung Lee, MSEE C. David Cooke, MD Nikhil Goyal, MSEE Mauricio Santos Sanchez, MSEE Russel D. Folks, PhD Zhengjia Chen, PhD John Votaw, MD, PhD Bon-Kwon Koo, MD, PhD Hee-Seung Bom
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The online version of this article (doi:https://​doi.​org/​10.​1007/​s12350-018-01472-3) contains supplementary material, which is available to authorized users.
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The goal of the present work is to present a novel methodology for the extraction of MBF, MFR and RFR along coronary arteries by means of multimodality image fusion of dynamic PET and CCTA images.


FFR is the reference standard to identify flow-limiting lesions, but its invasiveness limits broad application. New noninvasive methodologies are warranted to stratify patients and guide treatment.


A group of 16 low-risk CAD subjects who underwent both 13NH3 PET and CCTA were analyzed. Image fusion techniques were employed to align the studies and CCTA-derived anatomy used to identify coronaries trajectories. MBF was calculated by means of a 1-tissue compartmental model for the standard vascular territories and along patient-specific vessel paths from the base to the apex of the heart.


Low-risk ranges for MBF. MFR and RFR for LAD, LCX and rPDA were computed for the entire cohort and separated by gender. Computed low-risk ranges were used to assess a prospective patient with suspected CAD.


Our vessel-specific functional indexes and 3D displays offer promise to more closely replicate what is commonly performed during a catheterization session and have the potential of providing effective noninvasive tools for the identification of flow-limiting lesions and image-guided therapy.

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