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PET/CT scanning with 3D acquisition is feasible for quantifying myocardial blood flow when diagnosing coronary artery
Osamu Manabe1, Masanao Naya2, Tadao Aikawa3
1Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Insights
Quantifying myocardial blood flow (MBF) and coronary flow reserve (CFR) using 15O-water PET/CT with 3D acquisition is reliable for assessing coronary artery disease (CAD). This method accurately measures functional MBF and CFR in patients with suspected or known CAD.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Radiology
Background:
- Myocardial blood flow (MBF) and coronary flow reserve (CFR) are crucial for evaluating coronary artery disease (CAD) severity.
- 15O-water positron emission tomography (PET) is the gold standard for MBF quantification.
- Validation of 15O-water PET/CT with 3D acquisition for MBF and CFR measurement is needed.
Purpose of the Study:
- To evaluate the diagnostic potential of MBF and CFR measurements using 15O-water PET/CT.
- To compare MBF and CFR values between patients with suspected CAD and healthy controls.
- To assess the reliability and reproducibility of 3D 15O-water PET/CT for functional assessment of CAD.
Main Methods:
- 32 patients (24 with suspected CAD, 8 controls) underwent rest and stress 15O-water PET/CT.
- Whole and regional MBF (LAD, LCX, RCA territories) were quantified.
- CFR was calculated as the ratio of stress MBF to rest MBF. Inter-observer variability was assessed.
Main Results:
- 15O-water PET/CT with 3D acquisition demonstrated good image quality and strong inter-observer correlation (r > 0.90).
- Healthy volunteers showed no significant differences in regional MBF or CFR.
- Global CFR was significantly lower in CAD patients (2.75 ± 0.81) compared to controls (4.54 ± 0.66), p < 0.0002.
- Regional CFR tended to be lower in stenotic regions of CAD patients.
Conclusions:
- 15O-water PET/CT with 3D data acquisition reliably quantifies functional MBF and CFR.
- This technique is valuable for diagnosing and assessing the severity of CAD.
- The study validates the use of advanced PET/CT imaging for cardiovascular functional assessment.
Background:
The quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR) are useful approaches for evaluating the functional severity of coronary artery disease (CAD). 15O-water positron emission tomography (PET) is considered the gold standard method for MBF quantification. However, MBF measurements in 15O-water PET with three-dimensional (3D) data acquisition, attenuation correction using computed tomography (CT), and time of flight have not been investigated in detail or validated. We conducted this study to evaluate the diagnostic potential of MBF measurements using PET/CT for a comparison of a control group and patients suspected of having CAD.
Results:
Twenty-four patients with known or suspected CAD and eight age-matched healthy volunteers underwent rest and pharmacological stress perfusion studies with 15O-water PET/CT. The whole and three regional (left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) territory) MBF values were estimated. The CFR was computed as the ratio of the MBF during adenosine triphosphate-induced stress to the MBF at rest. The inter-observer variability was assessed by two independent observers. PET/CT using a 15O-water dose of 500 MBq and 3D data acquisition showed good image quality. A strong inter-observer correlation was detected in both the whole MBF analysis and the regional analysis with high intra-class correlation coefficients (r > 0.90, p < 0.001). Regional MBF at rest (LAD, 0.82 ± 0.15 ml/min/g; LCX, 0.83 ± 0.17 ml/min/g; RCA, 0.71 ± 0.20 ml/min/g; p = 0.74), MBF at stress (LAD, 3.77 ± 1.00 ml/min/g; LCX, 3.56 ± 1.01 ml/min/g; RCA, 3.27 ± 1.04 ml/min/g; p = 0.62), and CFR (LAD, 4.64 ± 0.90; LCX, 4.30 ± 0.64; RCA, 4.64 ± 0.96; p = 0.66) of the healthy volunteers showed no significant difference among the three regions. The global CFR of the patients was significantly lower than that of the volunteers (2.75 ± 0.81 vs. 4.54 ± 0.66, p = 0.0002). The regional analysis of the patients demonstrated that the CFR tended to be lower in the stenotic region compared to the non-stenotic region (2.43 ± 0.81 vs. 2.95 ± 0.92, p = 0.052).
Conclusions:
15O-water PET/CT with 3D data acquisition can be reliably used for the quantification of functional MBF and CFR in CAD patients.
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