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Improved myocardial blood flow estimation with residual activity correction and motion correction in 18F-flurpiridaz PET myocardial perfusion imaging

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

Abstract

Purpose

We sought to evaluate the diagnostic performance for coronary artery disease (CAD) of myocardial blood flow (MBF) quantification with 18F-flurpiridaz PET using motion correction (MC) and residual activity correction (RAC).

Methods

In total, 231 patients undergoing same-day pharmacologic rest and stress 18F-flurpiridaz PET from Phase III Flurpiridaz trial (NCT01347710) were studied. Frame-by-frame MC was performed and RAC was accomplished by subtracting the rest residual counts from the dynamic stress polar maps. MBF and myocardial flow reserve (MFR) were derived with a two-compartment early kinetic model for the entire left ventricle (global), each coronary territory, and 17-segment. Global and minimal values of three territorial (minimal vessel) and segmental estimation (minimal segment) of stress MBF and MFR were evaluated in the prediction of CAD. MBF and MFR were evaluated with and without MC and RAC (1: no MC/no RAC, 2: no MC/RAC, 3: MC/RAC).

Results

The area-under the receiver operating characteristics curve (AUC [95% confidence interval]) of stress MBF with MC/RAC was higher for minimal segment (0.89 [0.85–0.94]) than for minimal vessel (0.86 [0.81–0.92], p = 0.03) or global estimation (0.81 [0.75–0.87], p < 0.0001). The AUC of MFR with MC/RAC was higher for minimal segment (0.87 [0.81–0.93]) than for minimal vessel (0.83 [0.76–0.90], p = 0.014) or global estimation (0.77 [0.69–0.84], p < 0.0001). The AUCs of minimal segment stress MBF and MFR with MC/RAC were higher compared to those with no MC/RAC (p < 0.001 for both) or no MC/no RAC (p < 0.0001 for both).

Conclusions

Minimal segment MBF or MFR estimation with MC and RAC improves the diagnostic performance for obstructive CAD compared to global assessment.

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Abbreviations

AUC:

ARea under the receiver operating characteristic curve

CAD:

Coronary artery disease

CI:

Confidence interval

ICA:

Invasive coronary angiogram

IQR:

Interquartile range

LAD:

Left anterior descending artery

LCX:

Left circumflex

LV:

Left ventricle

MBF:

Myocardial blood flow

MC:

Motion correction

MFR:

Myocardial flow reserve

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

RAC:

Residual activity correction

RCA:

Right coronary artery

ROI:

Region of interest

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Author information

Authors and Affiliations

  1. Department of Medicine (Division of Artificial Intelligence)- Imaging- and Biomedical Sciences- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, CA, 90048, USA

    Yuka Otaki, Serge D. Van Kriekinge, Chih-Chun Wei, Paul Kavanagh, Ananya Singh, Tejas Parekh, Daniel S. Berman & Piotr J. Slomka

  2. Cardiovascular Imaging Program, Departments of Medicine and Radiology and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Marcelo Di Carli

  3. Division of Nuclear Medicine, Department of Molecular and Medical Pharmacology and Division of Cardiology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Jamshid Maddahi

  4. Sano Centre for Computational Medicine, Cracow, Malopolskie, Poland

    Arkadiusz Sitek

  5. GE Healthcare, Pharmaceutical Diagnostics, Buckinghamshire, UK

    Christopher Buckley

Authors
  1. Yuka Otaki
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  10. Christopher Buckley
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Contributions

Dr. Slomka conceived of the presented idea. Dr. Otaki developed the theory, performed imaging processing, statistical analysis, and wrote the manuscript. Dr. Slomka, Dr. Van Kriekinge, Mr. Wei, and Mr. Kavanagh developed the imaging software for this analysis. Ms. Singh and Mr. Parekh quality-checked the software. Drs. Di Carli, Maddahi, Sitek, Buckley, and Berman critically reviewed the manuscript. Drs. Slomka and Otaki to complete this work. All authors discussed the results and contributed to the final manuscript. The authors thank Cathleen Huang for additional data analysis and independent verification of the results.

Corresponding author

Correspondence to Piotr J. Slomka.

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Conflict of interest

Dr. Berman, Dr. Slomka, and Mr. Paul Kavanagh participate in software royalties for QPET software at Cedars-Sinai Medical Center. Dr. Slomka has received research grant support from Siemens Medical Systems. Dr. Maddahi is Chair of the Publication Committee and a member of the Scientific Advisory Committee at GE Healthcare for the Flurpiridaz project. Dr. Berman has served as a consultant for GE Healthcare. Dr. Di Carli has received institutional research grant support from Spectrum Dynamics and Gilead Sciences.

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Otaki, Y., Van Kriekinge, S.D., Wei, CC. et al. Improved myocardial blood flow estimation with residual activity correction and motion correction in 18F-flurpiridaz PET myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 49, 1881–1893 (2022). https://doi.org/10.1007/s00259-021-05643-2

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  • DOI: https://doi.org/10.1007/s00259-021-05643-2

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