Assessment of endothelial function and myocardial flow reserve using 15O-water PET without attenuation correction

  • Stéphane Tuffier
  • Damien Legallois
  • Annette Belin
  • Michael Joubert
  • Alban Bailliez
  • Michel Redonnet
  • Denis Agostini
  • Alain ManriqueEmail author
Original Article



Myocardial blood flow (MBF) measurement using positron emission tomography (PET) from the washout rate of 15O-water is theoretically independent of tissue attenuation. The aim of this study was to evaluate the impact of not using attenuation correction in the assessment of coronary endothelial function and myocardial flow reserve (MFR) using 15O-water PET.


We retrospectively processed 70 consecutive 15O-water PET examinations obtained at rest and during cold pressor testing (CPT) in patients with dilated cardiomyopathy (n = 58), or at rest and during adenosine infusion in heart transplant recipients (n = 12). Data were reconstructed with attenuation correction (AC) and without attenuation correction (NAC) using filtered backprojection, and MBF was quantified using a single compartmental model. The agreement between AC and NAC data was assessed using Lin’s concordance correlation coefficient followed by Bland-Altman plot analysis.


Regarding endothelial function, NAC PET showed poor reproducibility and poor agreement with AC PET data. Conversely, NAC PET demonstrated high reproducibility and a strong agreement with AC PET for the assessment of MFR.


Non-attenuation-corrected 15O-water PET provided an accurate measurement of MFR compared to attenuation-corrected PET. However, non-attenuation-corrected PET data were less effective for the assessment of endothelial function using CPT in this population.


Positron emission tomography Myocardial perfusion 15O-water Attenuation correction Endothelial function Myocardial flow reserve 



Sophie De Bouard, Brigitte David, Marie-Hermine Noel, Marie-Christine Onfroy, Christelle Lebouleux, Ahmed Abbas and Olivier Tirel are acknowledged for their technical assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


This work was supported in part by an institutional grant from the Caen University Hospital (AOI 2008-09/089).

Statement of human rights

All examinations were performed as part of prospective investigations approved by our regional ethics committee (CPP Nord Ouest III), and all patients gave written informed consent before initial enrolment.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Stéphane Tuffier
    • 1
  • Damien Legallois
    • 1
    • 2
  • Annette Belin
    • 3
  • Michael Joubert
    • 1
  • Alban Bailliez
    • 1
  • Michel Redonnet
    • 4
  • Denis Agostini
    • 1
    • 5
  • Alain Manrique
    • 1
    • 5
    • 6
    Email author
  1. 1.Normandie UniversitéEA 4650CaenFrance
  2. 2.Department of CardiologyCaen University HospitalCaenFrance
  3. 3.Department of Cardiac SurgeryCaen University HospitalCaenFrance
  4. 4.Department of Cardiac SurgeryRouen University HospitalRouenFrance
  5. 5.Department of Nuclear MedicineCaen University HospitalCaenFrance
  6. 6.Cyceron PET CentreCaenFrance

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