Edward P Ficaro1,2, Venkatesh L Murthy2, Alexis Poitrasson-Rivière3, Jonathan B Moody1, Jennifer M Renaud1, Tomoe Hagio1, Liliana Arida-Moody2, Christopher Buckley4, Richard L Weinberg5. 1. INVIA Medical Imaging Solutions, 3025 Boardwalk Drive, Suite 200, Ann Arbor, MI, 48108, USA. 2. Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA. 3. INVIA Medical Imaging Solutions, 3025 Boardwalk Drive, Suite 200, Ann Arbor, MI, 48108, USA. apoitrasson@inviasolutions.com. 4. GE Pharmaceutical Diagnostics R&D, Amersham, UK. 5. Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Abstract
BACKGROUND: 13N-ammonia and 18F-flurpiridaz require longer delays between rest and stress studies to allow for decay, lowering clinical throughput. In this study, we investigated the impact of residual subtraction on MBF and MFR estimates, as well as its effects on diagnostic accuracy. METHODS: We retrospectively analyzed 63 patients who underwent a dynamic ammonia rest/stress study and 231 patients from the flurpiridaz 301 trial. Residual subtraction was performed by subtracting the mean pre-injection activity in each sampled region from that region's time activity curve. Corrected and uncorrected MBF and MFR were analyzed. Diagnostic accuracy was compared to quantitative coronary angiograms (QCA) for the flurpiridaz population. RESULTS: With delays between injections above 3 half-lives, and a doubled stress dose, residual activity did not meaningfully increase ammonia MBF (< 5%). For shorter injection delays, stress MBF was overestimated by 13.6% ± 5.0% (P < .001). Residual activity had a large effect on flurpiridaz stress MBF, overestimating it by 37.9% ± 23.2% (P < .001). Comparison to QCA showed a significant improvement in AUC with residual subtraction (from 0.748 to 0.831, P = .001). MFR yielded similar results. CONCLUSIONS: Accounting for residual activity has a marked impact on stress MBF and MFR and improves diagnostic accuracy relative to QCA.
BACKGROUND: 13N-ammonia and 18F-flurpiridaz require longer delays between rest and stress studies to allow for decay, lowering clinical throughput. In this study, we investigated the impact of residual subtraction on MBF and MFR estimates, as well as its effects on diagnostic accuracy. METHODS: We retrospectively analyzed 63 patients who underwent a dynamic ammonia rest/stress study and 231 patients from the flurpiridaz 301 trial. Residual subtraction was performed by subtracting the mean pre-injection activity in each sampled region from that region's time activity curve. Corrected and uncorrected MBF and MFR were analyzed. Diagnostic accuracy was compared to quantitative coronary angiograms (QCA) for the flurpiridaz population. RESULTS: With delays between injections above 3 half-lives, and a doubled stress dose, residual activity did not meaningfully increase ammonia MBF (< 5%). For shorter injection delays, stress MBF was overestimated by 13.6% ± 5.0% (P < .001). Residual activity had a large effect on flurpiridaz stress MBF, overestimating it by 37.9% ± 23.2% (P < .001). Comparison to QCA showed a significant improvement in AUC with residual subtraction (from 0.748 to 0.831, P = .001). MFR yielded similar results. CONCLUSIONS: Accounting for residual activity has a marked impact on stress MBF and MFR and improves diagnostic accuracy relative to QCA.
Authors: S G Nekolla; S Reder; A Saraste; T Higuchi; G Dzewas; A Preissel; M Huisman; T Poethko; T Schuster; M Yu; S Robinson; D Casebier; J Henke; H J Wester; M Schwaiger Journal: Circulation Date: 2009-04-20 Impact factor: 29.690
Authors: Justin Pieper; Vaiibhav N Patel; Richard L Weinberg; Venkatesh L Murthy; Sylvia Escolero; Jacob R Nelson; Alexis Poitrasson-Rivière; Christopher K Shreves; Nick Freiburger; David Hubers; Jill Rothley; James R Corbett; Joseph Oliverio; Edward P Ficaro Journal: J Nucl Cardiol Date: 2019-09-12 Impact factor: 5.952
Authors: Piotr J Slomka; Jonathan B Moody; Robert J H Miller; Jennifer M Renaud; Edward P Ficaro; Ernest V Garcia Journal: J Nucl Cardiol Date: 2020-10-16 Impact factor: 5.952
Authors: Chengyi Zheng; Benjamin C Sun; Yi-Lin Wu; Maros Ferencik; Ming-Sum Lee; Rita F Redberg; Aniket A Kawatkar; Visanee V Musigdilok; Adam L Sharp Journal: J Nucl Cardiol Date: 2020-11-05 Impact factor: 3.872