Precision and accuracy of clinical quantification of myocardial blood flow by dynamic PET: A technical perspective


A number of exciting advances in PET/CT technology and improvements in methodology have recently converged to enhance the feasibility of routine clinical quantification of myocardial blood flow and flow reserve. Recent promising clinical results are pointing toward an important role for myocardial blood flow in the care of patients. Absolute blood flow quantification can be a powerful clinical tool, but its utility will depend on maintaining precision and accuracy in the face of numerous potential sources of methodological errors. Here we review recent data and highlight the impact of PET instrumentation, image reconstruction, and quantification methods, and we emphasize 82Rb cardiac PET which currently has the widest clinical application. It will be apparent that more data are needed, particularly in relation to newer PET technologies, as well as clinical standardization of PET protocols and methods. We provide recommendations for the methodological factors considered here. At present, myocardial flow reserve appears to be remarkably robust to various methodological errors; however, with greater attention to and more detailed understanding of these sources of error, the clinical benefits of stress-only blood flow measurement may eventually be more fully realized.

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Figure 1
Figure 2
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Figure 6



Myocardial Perfusion Imaging


Myocardial Blood Flow


Myocardial Flow Reserve


Time of Flight


Repeatability Coefficient


Filtered Back Projection


3D Reprojection (i.e., 3D FBP)


Ordered Subsets Expectation Maximization


Point Spread Function


Left Ventricle


Right Ventricle


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J.B. Moody and B.C. Lee are employees of INVIA Medical Imaging Solutions, E.P. Ficaro and J.R. Corbett are stockholders of INVIA Medical Imaging Solutions, and V.L. Murthy has received research support from INVIA Medical Imaging Solutions, which produces a software package for myocardial blood flow estimation. V.L. Murthy has minor stock holdings in General Electric, Mallinckrodt, and Cardinal Health.

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Correspondence to Venkatesh L. Murthy MD, PhD.

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Moody, J.B., Lee, B.C., Corbett, J.R. et al. Precision and accuracy of clinical quantification of myocardial blood flow by dynamic PET: A technical perspective. J. Nucl. Cardiol. 22, 935–951 (2015).

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  • Myocardial blood flow
  • Myocardial flow reserve
  • Cardiac PET/CT
  • Rubidium-82