Related Experiment Video
Updated: Jul 5, 2025
High-Resolution Cardiac Positron Emission Tomography/Computed Tomography for Small Animals
Published on: December 16, 2022
Downward myocardial creep during stress PET imaging is inversely associated with mortality
Keiichiro Kuronuma1,2, Robert J H Miller1,3, Chih-Chun Wei1
1Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Purpose:
The myocardial creep is a phenomenon in which the heart moves from its original position during stress-dynamic PET myocardial perfusion imaging (MPI) that can confound myocardial blood flow measurements. Therefore, myocardial motion correction is important to obtain reliable myocardial flow quantification. However, the clinical importance of the magnitude of myocardial creep has not been explored. We aimed to explore the prognostic value of myocardial creep quantified by an automated motion correction algorithm beyond traditional PET-MPI imaging variables.
Methods:
Consecutive patients undergoing regadenoson rest-stress [82Rb]Cl PET-MPI were included. A newly developed 3D motion correction algorithm quantified myocardial creep, the maximum motion at stress during the first pass (60 s), in each direction. All-cause mortality (ACM) served as the primary endpoint.
Results:
A total of 4,276 patients (median age 71 years; 60% male) were analyzed, and 1,007 ACM events were documented during a 5-year median follow-up. Processing time for automatic motion correction was < 12 s per patient. Myocardial creep in the superior to inferior (downward) direction was greater than the other directions (median, 4.2 mm vs. 1.3-1.7 mm). Annual mortality rates adjusted for age and sex were reduced with a larger downward creep, with a 4.2-fold ratio between the first (0 mm motion) and 10th decile (11 mm motion) (mortality, 7.9% vs. 1.9%/year). Downward creep was associated with lower ACM after full adjustment for clinical and imaging parameters (adjusted hazard ratio, 0.93; 95%CI, 0.91-0.95; p < 0.001). Adding downward creep to the standard PET-MPI imaging model significantly improved ACM prediction (area under the receiver operating characteristics curve, 0.790 vs. 0.775; p < 0.001), but other directions did not (p > 0.5).
Conclusions:
Downward myocardial creep during regadenoson stress carries additional information for the prediction of ACM beyond conventional flow and perfusion PET-MPI. This novel imaging biomarker is quantified automatically and rapidly from stress dynamic PET-MPI.
Insights
Myocardial creep, or heart motion during PET scans, can impact blood flow measurements. Greater downward heart motion during stress PET imaging predicts lower all-cause mortality, offering a new prognostic tool.
Area of Science:
- Cardiology
- Medical Imaging
- Nuclear Medicine
Background:
- Myocardial creep, heart motion during PET scans, can affect blood flow measurements.
- Accurate myocardial flow quantification requires motion correction.
- The prognostic significance of myocardial creep magnitude is not well understood.
Purpose of the Study:
- To investigate the prognostic value of myocardial creep.
- To quantify myocardial creep using an automated motion correction algorithm.
- To assess if myocardial creep provides additional prognostic information beyond traditional PET-MPI variables.
Main Methods:
- Patients undergoing regadenoson stress-rest [82Rb]Cl PET-MPI were included.
- A 3D motion correction algorithm quantified myocardial creep (maximum motion at stress).
- All-cause mortality (ACM) was the primary endpoint.
Main Results:
- Downward myocardial creep was more pronounced than in other directions.
- Increased downward creep correlated with reduced annual mortality rates.
- Downward creep significantly improved ACM prediction when added to the PET-MPI model.
Conclusions:
- Downward myocardial creep during stress PET-MPI is a novel imaging biomarker.
- This biomarker offers additional prognostic information for ACM prediction.
- It is quantified automatically and rapidly from stress dynamic PET-MPI.
