Washout of 82Rb as a marker of impaired tissue integrity, obtained by list-mode cardiac PET/CT: relationship with perfusion/metabolism patterns of myocardial viability

  • David T. Chien
  • Paco Bravo
  • Takahiro Higuchi
  • Jennifer Merrill
  • Frank M. Bengel
Original Article



Myocardial washout of the potassium analogue 82Rb may indicate tissue impairment. Few studies have evaluated its usefulness for viability assessment, and controversial results were reported. We revisited this topic using list-mode positron emission tomography (PET)/CT.


A total of 22 patients with chronic ischemic cardiomyopathy (ICM) and 11 control subjects with normal CT coronary angiogram were studied. Rest 82Rb PET/CT studies were acquired in list mode and resampled to static, gated, and dynamic images. Using a 17-segment model, 82Rb washout was determined by monoexponential fitting of myocardial time-activity curves. In ICM patients, 18F-fluorodeoxyglucose (FDG) studies were obtained in the same session and segments were classified as normally perfused, mismatch, or matched defect.


82Rb washout was minimal and homogeneous in control subjects. Normally perfused segments of ICM did not differ (p = 0.33). ICM patients had a left ventricular ejection fraction (LVEF) of 25 ± 12%, 25/353 mismatched, and 46/353 matched defect segments. 82Rb washout was higher in hypoperfused vs normal segments (p < 0.05), but not different between mismatch and matched defect (p = 0.18). Intraindividual analysis in nine patients showing both FDG mismatch and matched defect confirmed absence of differences. Overall, segmental 82Rb washout correlated inversely with 82Rb uptake (r = −0.70; p < 0.05) and less well with FDG uptake (r = −0.31; p < 0.05).


Using state-of-the-art PET/CT technology for myocardial viability assessment, 82Rb washout does not distinguish between perfusion/metabolism patterns of hibernating myocardium and scar. Tissue integrity may be at least partially impaired in hibernation.


82Rb Membrane integrity FDG Myocardial viability PET/CT 


Conflicts of interest



  1. 1.
    Mullani NA, Goldstein RA, Gould KL, Marani SK, Fisher DJ, O’Brien HA, et al. Myocardial perfusion with rubidium-82. I. Measurement of extraction fraction and flow with external detectors. J Nucl Med 1983;24:898–906.PubMedGoogle Scholar
  2. 2.
    Bengel FM, Higuchi T, Javadi MS, Lautamäki R. Cardiac positron emission tomography. J Am Coll Cardiol 2009;54:1–15.PubMedCrossRefGoogle Scholar
  3. 3.
    Di Carli MF, Hachamovitch R. New technology for noninvasive evaluation of coronary artery disease. Circulation 2007;115:1464–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Gould KL, Yoshida K, Hess MJ, Haynie M, Mullani N, Smalling RW. Myocardial metabolism of fluorodeoxyglucose compared to cell membrane integrity for the potassium analogue rubidium-82 for assessing infarct size in man by PET. J Nucl Med 1991;32:1–9.PubMedGoogle Scholar
  5. 5.
    vom Dahl J, Muzik O, Wolfe Jr ER, Allman C, Hutchins G, Schwaiger M. Myocardial rubidium-82 tissue kinetics assessed by dynamic positron emission tomography as a marker of myocardial cell membrane integrity and viability. Circulation 1996;93:238–45.Google Scholar
  6. 6.
    Stankewicz MA, Mansour CS, Eisner RL, Churchwell KB, Williams BR, Sigman SR, et al. Myocardial viability assessment by PET: (82)Rb defect washout does not predict the results of metabolic-perfusion mismatch. J Nucl Med 2005;46:1602–9.PubMedGoogle Scholar
  7. 7.
    Kemp BJ, Kim C, Williams JJ, Ganin A, Lowe VJ, National Electrical Manufacturers Association (NEMA). NEMA NU 2-2001 performance measurements of an LYSO-based PET/CT system in 2D and 3D acquisition modes. J Nucl Med 2006;47:1960–7.PubMedGoogle Scholar
  8. 8.
    Lautamäki R, Brown TL, Merrill J, Bengel FM. CT-based attenuation correction in (82)Rb-myocardial perfusion PET-CT: incidence of misalignment and effect on regional tracer distribution. Eur J Nucl Med Mol Imaging 2008;35:305–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Chander A, Brenner M, Lautamäki R, Voicu C, Merrill J, Bengel FM. Comparison of measures of left ventricular function from electrocardiographically gated 82Rb PET with contrast-enhanced CT ventriculography: a hybrid PET/CT analysis. J Nucl Med 2008;49:1643–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Nekolla SG, Miethaner C, Nguyen N, Ziegler SI, Schwaiger M. Reproducibility of polar map generation and assessment of defect severity and extent assessment in myocardial perfusion imaging using positron emission tomography. Eur J Nucl Med 1998;25:1313–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42.PubMedCrossRefGoogle Scholar
  12. 12.
    Lautamäki R, George RT, Kitagawa K, Higuchi T, Merrill J, Voicu C, et al. Rubidium-82 PET-CT for quantitative assessment of myocardial blood flow: validation in a canine model of coronary artery stenosis. Eur J Nucl Med Mol Imaging 2009;36:576–86.PubMedCrossRefGoogle Scholar
  13. 13.
    Beanlands RS, Hendry PJ, Masters RG, deKemp RA, Woodend K, Ruddy TD. Delay in revascularization is associated with increased mortality rate in patients with severe left ventricular dysfunction and viable myocardium on fluorine 18-fluorodeoxyglucose positron emission tomography imaging. Circulation 1998;98(19 Suppl):II51–6.PubMedGoogle Scholar
  14. 14.
    Haas F, Augustin N, Holper K, Wottke M, Haehnel C, Nekolla S, et al. Time course and extent of improvement of dysfunctioning myocardium in patients with coronary artery disease and severely depressed left ventricular function after revascularization: correlation with positron emission tomographic findings. J Am Coll Cardiol 2000;36:1927–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Maes A, Flameng W, Nuyts J, Borgers M, Shivalkar B, Ausma J, et al. Histological alterations in chronically hypoperfused myocardium. Correlation with PET findings. Circulation 1994;90:735–45.PubMedGoogle Scholar
  16. 16.
    Knuesel PR, Nanz D, Wyss C, Buechi M, Kaufmann PA, von Schulthess GK, et al. Characterization of dysfunctional myocardium by positron emission tomography and magnetic resonance: relation to functional outcome after revascularization. Circulation 2003;108:1095–100.PubMedCrossRefGoogle Scholar
  17. 17.
    Grunwald AM, Watson DD, Holzgrefe Jr HH, Irving JF, Beller GA. Myocardial thallium-201 kinetics in normal and ischemic myocardium. Circulation 1981;64:610–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Brown KA, Benoit L, Clements JP, Wackers FJ. Fast washout of thallium-201 from area of myocardial infarction: possible artifact of background subtraction. J Nucl Med 1987;28:945–9.PubMedGoogle Scholar
  19. 19.
    Machac J. Cardiac positron emission tomography imaging. Semin Nucl Med 2005;35:17–36.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • David T. Chien
    • 1
  • Paco Bravo
    • 1
  • Takahiro Higuchi
    • 1
  • Jennifer Merrill
    • 1
  • Frank M. Bengel
    • 1
    • 2
  1. 1.Division of Nuclear Medicine, Russell H Morgan Department of RadiologyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Nuclear MedicineHannover Medical SchoolHannoverGermany

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