Abstract
Objective
Myocardial blood flow (MBF) is measured with 82Rb using non-linear, least-squares computerised modelling. The study aim was to explore the feasibility of Gjedde–Patlak–Rutland (GPR) graphical analysis as a simpler method for measuring MBF.
Methods
Patients had myocardial perfusion imaging using adenosine (n = 45) or regadenoson (n = 33) for stressing. Blood 82Rb clearance into myocytes (K1) was measured from Cedar-Sinai QPET software using the modified Crone–Renkin equation of Lortie et al. (K1 = [1–0.77 × e−B/MBF] × MBF) to convert K1 to MBF (ml/min/100 ml), where B (63 ml/min/100 ml) is myocardial permeability-surface area product. Using aorta or left ventricular cavity (LV) to measure arterial blood 82Rb concentration, blood 82Rb clearance into myocardium (Z) was measured from GPR analysis based on data acquired between 1 and 3 min post-injection. As units of K1 and Z are, respectively, ml/min/ml intracellular space and ml/min/ml total tissue including extracellular space, myocardial extracellular fluid volume (ECV) is 1 − [Z/K1]. Using Z/K1 (see Results) to modify its index, the Lortie equation was changed to Z = (1–0.77 × \(e^{-B_Z/\text{MBF}_Z}\)e−BZ/MBFZ)*MBFZ, following which MBFZ was calculated from Z. In GPR analysis, spillover of activity from LV to myocardium conveniently ‘drops out’ in the intercept of the plot.
Results
Both agents increased myocardial blood flow almost equally. ECV was ~ 35 ml/100 ml at rest, increasing to ~ 40 ml/100 ml after stress. Z/K1, averaged between stress, rest, stressing agents and arterial ROI, was 0.62, so BZ was taken as 39 (i.e. 0.62 × 63) ml/min/100 ml. Based on LV, MBFZ (y) correlated with MBF (x): y = 0.43x + 22 ml/min/100 ml; r = 0.84; n = 156). Their respective stress/rest ratios showed a moderate correlation (r = 0.64; n = 78).
Conclusions
GPR analysis offers promise as a valid and analytically simpler technique for measuring myocardial blood flow, which, as with any clearance measured from GPR analysis, has units of ml/min/ml total tissue volume, and merits development as a polar map display.
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Sima Gregg declares she has no conflicts of interest. Georgia Keramida declares she has no conflicts of interest. A Michael Peters declares he has no conflicts of interest.
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Gregg, S., Keramida, G. & Peters, A.M. Measuring myocardial blood flow with 82rubidium using Gjedde–Patlak–Rutland graphical analysis. Ann Nucl Med 35, 777–784 (2021). https://doi.org/10.1007/s12149-021-01591-x
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DOI: https://doi.org/10.1007/s12149-021-01591-x