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Published on: December 28, 2013
Diagnostic value of regional myocardial flow reserve measurements using Rubidium-82 PET : Disclosures none
Sabine S Koenders1,2, Jorn A van Dalen3, Pieter L Jager4
1Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands. skoenders93@gmail.com.
Purpose:
Visual assessment of Rubidium (Rb-82) PET myocardial perfusion images is usually combined with global myocardial flow reserve (MFR) measurements. However, small regional blood flow deficits may go unnoticed. Our aim was to compare the diagnostic value of regional with global MFR in the detection of obstructive coronary artery disease (oCAD).
Methods:
We retrospectively included 1519 patients referred for rest and regadenoson-induced stress Rb-82 PET/CT without prior history of oCAD. MFR was determined globally, per vessel territory and per myocardial segment and compared using receiver-operating characteristic analysis. Vessel MFR was defined as the lowest MFR of the coronary territories and segmental MFR as the lowest MFR of the 17-segments. The primary endpoint was oCAD on invasive coronary angiography.
Results:
The 148 patients classified as having oCAD had a lower global MFR (median 1.9, interquartile range [1.5-2.4] vs. 2.4 [2.0-2.9]), lower vessel MFR (1.6 [1.2-2.1] vs. 2.2 [1.9-2.6]) and lower segmental MFR (1.3 [ 0.9-1.6] vs. 1.8 [1.5-2.2]) as compared to the non-oCAD patients (p < 0.001). The area under the curve for segmental MFR (0.81) was larger (p ≤ 0.005) than of global MFR (0.74) and vessel MFR (0.78).
Conclusions:
The use of regional MFR instead of global MFR is recommended as it improves the diagnostic value of Rb-82 PET in the detection of oCAD.
Insights
Regional myocardial flow reserve (MFR) analysis of Rubidium-82 PET scans offers superior detection of obstructive coronary artery disease (oCAD) compared to global MFR. This approach enhances diagnostic accuracy for identifying oCAD.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Radiopharmaceutical PET Imaging
Background:
- Visual assessment of Rubidium-82 (Rb-82) PET myocardial perfusion images is standard practice.
- Global myocardial flow reserve (MFR) measurements are often combined with visual assessment.
- Subtle regional blood flow deficits may be missed by global assessments.
Purpose of the Study:
- To compare the diagnostic value of regional versus global MFR in detecting obstructive coronary artery disease (oCAD).
- To evaluate the utility of Rb-82 PET/CT in identifying oCAD.
Main Methods:
- Retrospective analysis of 1519 patients undergoing Rb-82 PET/CT for suspected oCAD.
- MFR was calculated globally, per vessel territory, and per myocardial segment.
- Receiver-operating characteristic analysis compared diagnostic performance against invasive coronary angiography.
Main Results:
- Patients with oCAD showed significantly lower global, vessel, and segmental MFR compared to non-oCAD patients (p < 0.001).
- Segmental MFR demonstrated a larger area under the curve (0.81) than global MFR (0.74) and vessel MFR (0.78), indicating superior diagnostic performance.
- Regional MFR analysis proved more effective in identifying oCAD.
Conclusions:
- Regional MFR analysis using Rb-82 PET/CT improves diagnostic accuracy for obstructive coronary artery disease.
- Utilizing regional MFR is recommended over global MFR for enhanced detection of oCAD.
- Rb-82 PET/CT with regional MFR analysis is a valuable tool for diagnosing oCAD.
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