Daniel Juneau1,2, Kai Yi Wu3,4, Nicole Kaps3,5, Jason Yao3, Jennifer M Renaud3,6, Rob S B Beanlands3, Terrence D Ruddy3, Robert A deKemp3. 1. Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada. daniel.juneau@umontreal.ca. 2. Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. daniel.juneau@umontreal.ca. 3. Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada. 4. Department of Medicine and Dentistry (Medicine), University of Alberta, Edmonton, AB, Canada. 5. Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada. 6. INVIA Medical Imaging Solutions, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Myocardial flow reserve (MFR) measurement provides incremental diagnostic and prognostic information. The objective of the current study was to investigate the application of a simplified model for the estimation of MFR using only the stress/rest myocardial activity ratio (MAR) in patients undergoing rest-stress cardiac PET MPI. METHODS AND RESULTS: Rest and dipyridamole stress dynamic PET imaging was performed in consecutive patients using 82Rb or 13NH3 (n = 250 each). Reference standard MFR was quantified using a standard one-tissue compartment model. Stress/rest myocardial activity ratio (MAR) was calculated using the LV-mean activity from 2 to 6 minutes post-injection. Simplified estimates of MFR (MFREST) were then calculated using an inverse power function. For 13NH3, there was good correlation between MFR and MFREST values (R = 0.63), with similar results for 82Rb (R = 0.73). There was no bias in the MFREST values with either tracer. The overall diagnostic performance of MFREST for detection of MFR < 2 was good with ROC area under the curve (AUC) = 83.2 ± 1.2% for 13NH3 and AUC = 90.4 ± 0.7% for 82Rb. CONCLUSION: MFR was estimated with good accuracy using 82Rb and 13NH3 with a simplified method that relies only on stress/rest activity ratios. This novel approach does not require dynamic imaging or tracer kinetic modeling. It may be useful for routine quality assurance of PET MFR measurements, or in scanners where full dynamic imaging and tracer kinetic modeling is not feasible for technical or logistical reasons.
BACKGROUND: Myocardial flow reserve (MFR) measurement provides incremental diagnostic and prognostic information. The objective of the current study was to investigate the application of a simplified model for the estimation of MFR using only the stress/rest myocardial activity ratio (MAR) in patients undergoing rest-stress cardiac PET MPI. METHODS AND RESULTS: Rest and dipyridamole stress dynamic PET imaging was performed in consecutive patients using 82Rb or 13NH3 (n = 250 each). Reference standard MFR was quantified using a standard one-tissue compartment model. Stress/rest myocardial activity ratio (MAR) was calculated using the LV-mean activity from 2 to 6 minutes post-injection. Simplified estimates of MFR (MFREST) were then calculated using an inverse power function. For 13NH3, there was good correlation between MFR and MFREST values (R = 0.63), with similar results for 82Rb (R = 0.73). There was no bias in the MFREST values with either tracer. The overall diagnostic performance of MFREST for detection of MFR < 2 was good with ROC area under the curve (AUC) = 83.2 ± 1.2% for 13NH3 and AUC = 90.4 ± 0.7% for 82Rb. CONCLUSION: MFR was estimated with good accuracy using 82Rb and 13NH3 with a simplified method that relies only on stress/rest activity ratios. This novel approach does not require dynamic imaging or tracer kinetic modeling. It may be useful for routine quality assurance of PET MFR measurements, or in scanners where full dynamic imaging and tracer kinetic modeling is not feasible for technical or logistical reasons.
Authors: Ran Klein; Jennifer M Renaud; Maria C Ziadi; Stephanie L Thorn; Andy Adler; Rob S Beanlands; Robert A deKemp Journal: J Nucl Cardiol Date: 2010-04-13 Impact factor: 5.952
Authors: Maria C Ziadi; Robert A Dekemp; Kathryn A Williams; Ann Guo; Benjamin J W Chow; Jennifer M Renaud; Terrence D Ruddy; Niroshi Sarveswaran; Rebecca E Tee; Rob S B Beanlands Journal: J Am Coll Cardiol Date: 2011-08-09 Impact factor: 24.094
Authors: R Glenn Wells; Rachel Timmins; Ran Klein; Julia Lockwood; Brian Marvin; Robert A deKemp; Lihui Wei; Terrence D Ruddy Journal: J Nucl Med Date: 2014-09-04 Impact factor: 10.057
Authors: Maria C Ziadi; Robert A Dekemp; Kathryn Williams; Ann Guo; Jennifer M Renaud; Benjamin J W Chow; Ran Klein; Terrence D Ruddy; May Aung; Linda Garrard; Rob S B Beanlands Journal: J Nucl Cardiol Date: 2012-03-14 Impact factor: 5.952
Authors: Piotr J Slomka; Erick Alexanderson; Rodrigo Jácome; Moises Jiménez; Edgar Romero; Aloha Meave; Ludovic Le Meunier; Magnus Dalhbom; Daniel S Berman; Guido Germano; Heinrich Schelbert Journal: J Nucl Med Date: 2012-01-06 Impact factor: 10.057
Authors: Sergey V Nesterov; Emmanuel Deshayes; John O Prior; Juhani M Knuuti; Roberto Sciagrà; Leonardo Settimo; Jerome M Declerck; Xiao-Bo Pan; Keiichiro Yoshinaga; Chietsugu Katoh; Piotr J Slomka; Guido Germano; Chunlei Han; Ville Aalto; Adam M Alessio; Edward P Ficaro; Benjamin C Lee; Stephan G Nekolla; Kilem L Gwet; Robert A deKemp; Ran Klein; John Dickson; James A Case; Timothy Bateman Journal: JACC Cardiovasc Imaging Date: 2014-10-08