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Impact of residual subtraction on myocardial blood flow and reserve estimates from rapid dynamic PET protocols

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

13N-ammonia and 18F-flurpiridaz require longer delays between rest and stress studies to allow for decay, lowering clinical throughput. In this study, we investigated the impact of residual subtraction on MBF and MFR estimates, as well as its effects on diagnostic accuracy.

Methods

We retrospectively analyzed 63 patients who underwent a dynamic ammonia rest/stress study and 231 patients from the flurpiridaz 301 trial. Residual subtraction was performed by subtracting the mean pre-injection activity in each sampled region from that region’s time activity curve. Corrected and uncorrected MBF and MFR were analyzed. Diagnostic accuracy was compared to quantitative coronary angiograms (QCA) for the flurpiridaz population.

Results

With delays between injections above 3 half-lives, and a doubled stress dose, residual activity did not meaningfully increase ammonia MBF (< 5%). For shorter injection delays, stress MBF was overestimated by 13.6% ± 5.0% (P < .001). Residual activity had a large effect on flurpiridaz stress MBF, overestimating it by 37.9% ± 23.2% (P < .001). Comparison to QCA showed a significant improvement in AUC with residual subtraction (from 0.748 to 0.831, P = .001). MFR yielded similar results.

Conclusions

Accounting for residual activity has a marked impact on stress MBF and MFR and improves diagnostic accuracy relative to QCA.

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Figure 1
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Abbreviations

PET:

Position emission tomography

CT:

Computed tomography

MPI:

Myocardial perfusion imaging

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

LV:

Left ventricle

CV:

Coefficient of variation

CAD:

Coronary artery disease

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Author notes

  1. Venkatesh L. Murthy and Edward P. Ficaro contributed equally to this work and are co-senior authors.

Authors and Affiliations

  1. INVIA Medical Imaging Solutions, 3025 Boardwalk Drive, Suite 200, Ann Arbor, MI, 48108, USA

    Alexis Poitrasson-Rivière, Jonathan B. Moody, Jennifer M. Renaud, Tomoe Hagio & Edward P. Ficaro

  2. Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA

    Liliana Arida-Moody, Edward P. Ficaro & Venkatesh L. Murthy

  3. GE Pharmaceutical Diagnostics R&D, Amersham, UK

    Christopher Buckley

  4. Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Richard L. Weinberg

Authors
  1. Alexis Poitrasson-Rivière
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  2. Jonathan B. Moody
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Corresponding author

Correspondence to Alexis Poitrasson-Rivière.

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Disclosures

A. Poitrasson-Rivière, J.B. Moody, T. Hagio, and J.M. Renaud are employees of INVIA. J.M. Renaud is a consultant for Jubilant DraxImage and receives royalties from the sales of FlowQuant® software. L. Arida-Moody has nothing to disclose. Christopher Buckley is an employee of GE Healthcare. R.L. Weinberg serves as a consultant for Ionetix and receives compensation for these services. E.P. Ficaro is a stockholder of INVIA, which produces Corridor4DM, a clinical software package for nuclear cardiology. V.L. Murthy is supported by R01AG059729 from the National Institute on Aging, U01DK123013 from the National Institute of Diabetes and Digestive and Kidney Disease, and R01HL136685 from the National Heart, Lung, and Blood Institute, as well as the Melvyn Rubenfire Professorship in Preventive Cardiology. Dr. Murthy has received research grants and speaking honoraria from Siemens Medical Imaging. He serves as a scientific advisor for Ionetix and owns stock options in the same. Dr. Murthy also owns stock in General Electric and Cardinal Health. He has received expert witness payments on behalf of Jubilant Draximage and a speaking honorarium from 2Quart Medical. Dr. Murthy receives non-financial research support from INVIA Medical Imaging Solutions.

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Poitrasson-Rivière, A., Moody, J.B., Renaud, J.M. et al. Impact of residual subtraction on myocardial blood flow and reserve estimates from rapid dynamic PET protocols. J. Nucl. Cardiol. 29, 2262–2270 (2022). https://doi.org/10.1007/s12350-021-02837-x

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  • DOI: https://doi.org/10.1007/s12350-021-02837-x

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