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Effects of two patient-specific dosing protocols on measurement of myocardial blood flow with 3D 82Rb cardiac PET

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Clinical measurement of myocardial blood flow (MBF) has emerged as an important component of routine PET-CT assessment of myocardial perfusion in patients with known or suspected coronary artery disease. Although multiple society guidelines recommend patient-specific dosing, there is a lack of studies evaluating the efficacy of patient-specific dosing for quantitative MBF accuracy.

Methods

Two patient-specific dosing protocols (weight- and BMI-adjusted) were retrospectively evaluated in 435 consecutive clinical patients referred for PET myocardial perfusion assessment. MBF was estimated at rest and after regadenoson-induced hyperemia. The effect of dosing protocol on dose reduction, PET scanner saturation, relative perfusion, and image quality was compared. The effect of PET saturation on the accuracy of MBF and myocardial flow reserve (MFR) in remote myocardium was assessed with multivariable linear regression.

Results

BMI-adjusted dosing was associated with lower administered 82Rb activities (1036.0 ± 274 vs. 1147 ± 274 MBq, p = 0.003) and lower PET scanner saturation incidence (28 vs. 38%, p = 0.006) and severity (median saturation severity index 0.219 ± 0.33 vs. 0.397 ± 0.59%, p = 0.018) compared to weight-adjusted dosing. PET saturation that occurred with either dosing protocol was moderate and resulted in modest remote MBF and MFR biases ranging from 2 to 9% after adjusting for patient age, sex, BMI, rate-pressure product, and LV ejection fraction. No adverse effects of BMI dose adjustment were observed in relative perfusion assessment or image quality.

Conclusions

Patient-specific dosing according to BMI is an effective method for guideline-directed dose reduction while maintaining image quality and accuracy for routine MBF and MFR quantification.

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Abbreviations

PET:

Positron emission tomography

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

BMI:

Body mass index

TOF:

Time of flight

DTF:

Dead time factor

LV:

Left ventricle

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Acknowledgements

The authors thank Michael E. Casey, PhD, and Mary Germino, PhD, for helpful discussions on PET saturation and dead time factor calculations.

Funding

VLM is supported by grants R01AG059729 from the National Institute on Aging, U01DK123013 from the National Institute of Diabetes and Digestive and Kidney Disease, and R01HL136685 from the National Heart, Lung, and Blood Institute as well as the Melvyn Rubenfire Professorship in Preventive Cardiology.

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Author notes

  1. Edward P Ficaro and Venkatesh L Murthy share equal contribution as co-senior authors.

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Liliana Arida-Moody, Edward P Ficaro & Venkatesh L Murthy

  2. INVIA, LLC, Ann Arbor, MI, USA

    Jonathan B Moody, Jennifer M Renaud, Alexis Poitrasson-Rivière, Tomoe Hagio & Edward P Ficaro

  3. Siemens Healthineers, Knoxville, TN, USA

    Anne M Smith

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  1. Liliana Arida-Moody
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Correspondence to Jonathan B Moody.

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This article does not contain any studies with human participants performed by any of the authors.

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All data were anonymized before analysis, and informed consent was not required under an exemption from the University of Michigan Institutional Review Board.

Conflict of interest

LAM declares that she has no conflict of interest; JBM, JMR, AP, and TH are employees of INVIA; AMS is an employee of Siemens Healthineers; EPF is a stockholder in INVIA. VLM has received research grants and speaking honoraria from Siemens Medical Imaging and serves as a scientific advisor for Ionetix and owns stock options in the same. He owns stock in GE and Cardinal Health, has received expert witness payments on behalf of Jubilant DraxImage and a speaking honorarium from 2Quart Medical, and receives nonfinancial research support from INVIA.

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Appendix

Dead time correction for our PET-CT scanner (Siemens Biograph mCT) was performed as part of the vendor’s component-based normalization [41]. The average total dead time factor was estimated as a function of detector singles rate using the following formula:

$$ DTF(S)=\frac{1}{{\left[1+S\cdot {c}_p+{\left(S\cdot {c}_{np}\right)}^2\right]}^2} $$
where S is the average singles rate per detector block (total singles rate divided by 192 detector blocks) and cp and cnp are the paralyzing and non-paralyzing coefficients obtained from the PET normalization file (for our mCT: −8.614 ∙ 10−7 and −2.875 ∙ 10−14 s/count).

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Arida-Moody, L., Moody, J.B., Renaud, J.M. et al. Effects of two patient-specific dosing protocols on measurement of myocardial blood flow with 3D 82Rb cardiac PET. Eur J Nucl Med Mol Imaging 48, 3835–3846 (2021). https://doi.org/10.1007/s00259-021-05385-1

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