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Internal validation of myocardial flow reserve PET imaging using stress/rest myocardial activity ratios with Rb-82 and N-13-ammonia

  • ORIGINAL ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Myocardial flow reserve (MFR) measurement provides incremental diagnostic and prognostic information. The objective of the current study was to investigate the application of a simplified model for the estimation of MFR using only the stress/rest myocardial activity ratio (MAR) in patients undergoing rest–stress cardiac PET MPI.

Methods and results

Rest and dipyridamole stress dynamic PET imaging was performed in consecutive patients using 82Rb or 13NH3 (n = 250 each). Reference standard MFR was quantified using a standard one-tissue compartment model. Stress/rest myocardial activity ratio (MAR) was calculated using the LV-mean activity from 2 to 6 minutes post-injection. Simplified estimates of MFR (MFREST) were then calculated using an inverse power function. For 13NH3, there was good correlation between MFR and MFREST values (R = 0.63), with similar results for 82Rb (R = 0.73). There was no bias in the MFREST values with either tracer. The overall diagnostic performance of MFREST for detection of MFR < 2 was good with ROC area under the curve (AUC) = 83.2 ± 1.2% for 13NH3 and AUC = 90.4 ± 0.7% for 82Rb.

Conclusion

MFR was estimated with good accuracy using 82Rb and 13NH3 with a simplified method that relies only on stress/rest activity ratios. This novel approach does not require dynamic imaging or tracer kinetic modeling. It may be useful for routine quality assurance of PET MFR measurements, or in scanners where full dynamic imaging and tracer kinetic modeling is not feasible for technical or logistical reasons.

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Abbreviations

AUC:

Area under the curve

CO:

Cardiac output

MAR:

Myocardial activity ratio

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

MPI:

Myocardial perfusion imaging

13NH3 :

Nitrogen-13-ammonia

PET:

Positron emission tomography

QA:

Quality assurance

82Rb:

Rubidium-82

ROC:

Receiver operator characteristic

SUV:

Standardized uptake value

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Disclosures

Jennifer Renaud is an employee of INVIA Medical Imaging Solutions, and a consultant for Jubilant DraxImage and receives revenues from the sales of FlowQuant software. Robert deKemp is consultant for- and received grant funding from Jubilant DraxImage, receives royalties from Rubidium-82 generator technologies licensed to Jubilant DraxImage, and from sales of FlowQuant software. Rob Beanlands is consultant for- and has received grant funding from GE Healthcare, Lantheus Medical Imaging, and Jubilant DraxImage. Daniel Juneau is consultant for Advanced Accelerator Applications, Pfizer, and AbbVie. Terrence Ruddy has received grant funding from GE Healthcare and Advanced Accelerator Applications and is a consultant for GE Healthcare and Ion Beam Applications (IBA) RadioPharma Solutions. All other authors declare that they have no conflicts of interest or disclosures.

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Author notes

  1. Daniel Juneau and Kai Yi Wu have contributed equally and are co-first authors.

Authors and Affiliations

  1. Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y4W7, Canada

    Daniel Juneau, Kai Yi Wu, Nicole Kaps, Jason Yao, Jennifer M. Renaud, Rob S. B. Beanlands, Terrence D. Ruddy & Robert A. deKemp

  2. Department of Nuclear Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Daniel Juneau

  3. Department of Medicine and Dentistry (Medicine), University of Alberta, Edmonton, AB, Canada

    Kai Yi Wu

  4. Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada

    Nicole Kaps

  5. INVIA Medical Imaging Solutions, Ann Arbor, MI, USA

    Jennifer M. Renaud

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Funding

Supported by Ontario Research Fund (Grant No. ORF-RE07-021). Daniel Juneau was supported by a research fellowship from CHUM and UOHI. Kai Yi Wu was supported by a summer research scholarship from the Heart and Stroke Foundation of Canada. Nicole Kaps was supported by the Canada Summer Jobs Program. Rob Beanlands is a Career Investigator supported by the Heart and Stroke Foundation of Ontario (HSFO), a Tier 1 Chair in Cardiac Imaging Research at the University of Ottawa and was Vered Chair in Cardiology at the University of Ottawa Heart Institute.

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Juneau, D., Wu, K.Y., Kaps, N. et al. Internal validation of myocardial flow reserve PET imaging using stress/rest myocardial activity ratios with Rb-82 and N-13-ammonia. J. Nucl. Cardiol. 28, 835–850 (2021). https://doi.org/10.1007/s12350-020-02464-y

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