Accuracy of low-dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and normal database interpretation
Our aim was to develop a normal database to be used for quantification of myocardial perfusion and diagnosis of “obstructive coronary artery disease” (CAD) using low-dose rubidium-82 three-dimensional (3D) positron emission tomography (PET)-CT.
From a record of 1,501 patients, 77 were identified as having low-likelihood (LLK) of CAD. Forty LLK patients were used to construct a normal database using 4DM-PET, the remainder used for validation of normalcy. A group of 70 patients with CAD who had invasive coronary angiography and PET-CT were used to evaluate the accuracy of the database for detecting CAD using the sum-stress-score. The effect of clinical exclusion criteria and the inclusion of LLK patients were evaluated.
The normal database for CAD detection had a normalcy rate of 95%. Sensitivity was 100% for detecting patients with either 50% or 70% stenosis. Optimal specificity was 87% for either 50% or 70% stenosis. For localizing disease at 50% stenosis in the left anterior descending, left circumflex, and right coronary artery, sensitivity ranged from 59% to 68%, while specificity was maintained at 87-89%. Similarly, at 70% stenosis, sensitivity ranged from 64% to 79%, and specificity from 87% to 91%.
A normal database containing the relative perfusion scores of patients with LLK of CAD can be used to accurately diagnose obstructive coronary disease using low-dose Rb-82 with 3D PET-CT imaging.
KeywordsPET-CT myocardial perfusion imaging normal relative perfusion coronary artery disease quantification
This study was supported by an operating grant from the Canadian Institute of Health Research (CIHR) for the Rb-ARMI trial (Grant MIS-100935). The study was also supported in part by the Molecular Function and Imaging (MFI) Program Grant from the Heart and Stroke Foundation of Ontario (Grant #PRG6242). R.S.B. is a Career Investigator supported by the HSFO. T.K. was supported in part by the University of Ottawa Undergraduate Research Opportunities Program. The authors would like to thank May Aung and Kimberly Gardner for acquisition of the rubidium PET-CT scans; Judy Etele for patient enrolment and consent; and Ann Guo for assistance with the statistical assessments.
RSB and RdK are consultants with Jubilant DRAXimage and have received grant funding from a government/industry program (partners: GE Healthcare, Nordion, Lantheus Medical Imaging, DRAXimage). RdK receives revenues from rubidium generator technology licensed to Jubilant DRAXimage. RSB is a consultant for Lantheus Medical Imaging.
- 6.Nakazato R, Berman DS, Dey D, Le Meunier L, Hayes SW, Fermin JS, et al. Automated quantitative Rb-82 3D PET/CT myocardial perfusion imaging: Normal limits and correlation with invasive coronary angiography. J Nucl Cardiol 2011; doi:10.1007/s12350-011-9496-3.
- 21.Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson E, Friedman JD, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996;27:1612-20.PubMedCrossRefGoogle Scholar
- 24.Cerquiera 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.CrossRefGoogle Scholar
- 25.Eng J. ROC analysis: Web-based calculator for ROC curves. Baltimore: Johns Hopkins University. Updated 2006 May 17; cited 17 Jan 2012. http://www.jrocfit.org.
- 28.Ziadi MC, deKemp RA, Williams K, Guo A, Renaud JM, Chow BJ, et al. Does quantification of myocardial flow reserve using Rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? J Nucl Cardiol 2012; doi:10.1007/s12350-011-9506-5.
- 30.Dorbala S, Vanagala D, Sampson U, Limaye A, Kwong R, Di Carli MF. Value of vasodilator left ventricular ejection fraction reserve in evaluating the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: A 82Rb PET/CT study. J Nucl Med 2007;48:349-58.PubMedGoogle Scholar