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The utility of 82Rb PET for myocardial viability assessment: Comparison with perfusion-metabolism 82Rb-18F-FDG PET

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

82Rb kinetics may distinguish scar from viable but dysfunctional (hibernating) myocardium. We sought to define the relationship between 82Rb kinetics and myocardial viability compared with conventional 82Rb and 18F-fluorodeoxyglucose (FDG) perfusion-metabolism PET imaging.

Methods

Consecutive patients (N = 120) referred for evaluation of myocardial viability prior to revascularization and normal volunteers (N = 37) were reviewed. Dynamic 82Rb 3D PET data were acquired at rest. 18F-FDG 3D PET data were acquired after metabolic preparation using a standardized hyperinsulinemic-euglycemic clamp. 82Rb kinetic parameters K1, k2, and partition coefficient (KP) were estimated by compartmental modeling

Results

Segmental 82Rb k2 and KP differed significantly between scarred and hibernating segments identified by Rb-FDG perfusion-metabolism (k2, 0.42 ± 0.25 vs. 0.22 ± 0.09 min−1; P < .0001; KP, 1.33 ± 0.62 vs. 2.25 ± 0.98 ml/g; P < .0001). As compared to Rb-FDG analysis, segmental Rb KP had a c-index, sensitivity and specificity of 0.809, 76% and 84%, respectively, for distinguishing hibernating and scarred segments. Segmental k2 performed similarly, but with lower specificity (75%, P < .001)

Conclusions

In this pilot study, 82Rb kinetic parameters k2 and KP, which are readily estimated using a compartmental model commonly used for myocardial blood flow, reliably differentiated hibernating myocardium and scar. Further study is necessary to evaluate their clinical utility for predicting benefit after revascularization.

Spanish Abstract

Antecedentes


La cinética con 82Rb puede distinguir las cicatrices miocárdicas del tejido viable pero disfuncional (hibernante). Buscamos definir la relación entre la cinética del 82Rb y la viabilidad miocárdica comparada con las imágenes convencionales de PET con 82Rb y 18F-flurodeoxyglucosa (FDG).

Métodos

se evaluaron a Pacientes Consecutivos (N = 120) referidos para evaluación de viabilidad miocárdica previos a revascularización y voluntarios normales (N = 37). Los datos de PET 3D dinámico con 82Rb fueron adquiridos en reposo. Los datos de 18F-FDG 3D PET fueron adquiridos posterior a la preparación metabólica usando un clamp hiperinsulínico-euglucémico. Los patrones cinéticos K1, k2 y el coeficiente de partición (KP) fueron estimados por el modelo compartimental.

Resultados

el k2 y KP del 82Rb permitueron distinguier el tejido cicatricial de los segmentos hibernados identificados por la vía perfusión metabolismo de Rb-FDG (k2, 0.42 ± 0.25 vs. 0.22 ± 0.09 min-1; P < .0001; KP, 1.33 ± 0.62 vs. 2.25 ± 0.98 ml/g; P < .0001). En comparación con el análisis de Rb-FDG, el KP segmentario del Rb tuvo un índice-c, sensbilidad y especificidad de 0.809 76 y 84%, respectivamente, para distinguir segmentos hibernantes y cicatriciales. k2 Segmentario tuvo un desempeño similar pero con una menor especificidad (75%, P < .001).

Conclusiones

En este estudio piloto, los parámetros cinéticos k2 y KP del 82Rb, los cuales son estimados usando un modelo compartimental usado comúnmente para flujo sanguíneo miocárdico, diferenciaron el miocardio hibernante del cicatricial. Se necesita estudiar más a fondo para evaluar la utilidad clínica para la predicción del beneficio posterior a la revascularización

Chinese Abstract

背景


铷-82(82Rb)药代动力学可能区分梗死与功能受损但存活的心肌(冬眠心肌)。我们将探讨82Rb药代动力学与存活心肌的关系,并与常规的82Rb和18F-氟脱氧葡萄糖(FDG)灌注-代谢PET显像进行比较。

方法

连续纳入120名血运重建前评估存活心肌的患者和37名正常志愿者。获得静息82Rb 3D-PET动态采集数据;采用标准化的高胰岛素 - 正葡萄糖钳夹试验得到18F-FDG 3D PET代谢显像数据; 通过房室模型计算82Rb动力学参数k1,k2和分配系数(KP)。

结果

以Rb-FDG灌注代谢显像鉴定疤痕心肌组和冬眠心肌组,两组的82Rb节段性 k2值和KP值有明显差异(k2, 0.42 ± 0.25 vs 0.22 ± 0.09 min−1; P < .0001; KP, 1.33 ± 0.62 vs 2.25 ± 0.98 ml/g; P < .0001)。以Rb-FDG灌注代谢显像为诊断标准,82Rb节段性 KP对疤痕和冬眠心肌鉴别效能的c指数,敏感性和特异性分别是0.809, 76%和84%。节段性k2的鉴别效能与KP相似,但特异性较低(75%,P < .001)。

结论

在本试验性研究中,通过常规用于82Rb心肌血流量测定的房室模型计算出的82Rb动力学参数k2和KP,可以有效的区分冬眠心肌和瘢痕心肌。 但需要进一步的研究来评估其对预测血运重建是否获益的临床价值。

French Abstract

Contexte


La cinétique du 82Rb pourrait être utilisée pour distinguer la fibrose myocardique des zones viables mais dysfonctionnelles (en hibernation). Dans cette étude, nous avons cherché à définir la relation entre la cinétique du 82Rb et la viabilité myocardique en comparant les images de perfusion et métabolisme myocardique utilisant le 82Rb et le 18F-fluorodésoxyglucose (FDG)

Méthodes

les données obtenues chez 120 patients consécutifs (N = 120) référés pour évaluation de la viabilité du myocarde avant revascularisation et 37 volontaires considérés normaux (N = 37) ont été étudieés. Les données TEP 3D dynamiques 82Rb ont été acquises au repos. Les données TEP 3D au 18F-FDG ont été acquises après préparation métabolique utilisant une pince hyperinsulémique-euglycémique normalisée. Les paramètres k1, k2 et le coefficient de partage (KP) de la cinétique du 82R bont été évalues par modélisation compartimentale.

Résultats

les paramètres k2 et KP de distribution du 82Rb se sont révélés significativement différent entre les zones tissulaires cicatricielles fibreuses et celles en hibernation identifiées par étude métabolique au FDG (k2, 0,42 ± 0,25 vs. 0,22 ± 0,09 min−1; P < 0,0001; KP, 1,33 ± 0,62 vs. 2,25 ± 0,98 ml/g; P < 0,0001). Par rapport aux données FDG, le paramètre KP du rubidium a révélé un indice de concordance de 0,809 et une sensibilité et spécificité de 76% et 84%, pour la distinction des segments en hibernation et cicatrisés. Les résultats du paramètre k2 se sont révélés similaires, mais avec une spécificité plus faible calculée à 75% (P < 0,001).

Conclusions

Dans cette étude pilote, les paramètres cinétiques k2 et KP de perfusion myocardique au 82Rb, qui sont facilement estimés à l’aide d’un modèle compartimental couramment utilisé pour flux sanguin myocardique, ont permis de différencier de manière fiable le myocarde cicatricielle des zones myocardiques hibernantes. Une étude plus approfondie est souhaitable pour valider leur utilité clinique en revacularisation.

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Abbreviations

PET:

Positron emission tomography

82Rb:

Rubidium-82

18F:

Fluorine-18

FDG:

Fluorodeoxyglucose

ICM:

Ischemic cardiomyopathy

GIR:

Glucose infusion rate

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Acknowledgements

The authors thank Erin Pollock and Amanda Melvin for assistance with data collection.

Disclosure

J.B. Moody, B.C. Lee, and A. Poitrasson-Rivière are employees of INVIA. K.M. Hiller has nothing to declare. R.L. Weinberg has nothing to declare. E.P. Ficaro and J.R. Corbett are stockholders of INVIA, which produces 4DM, a clinical software package for cardiac PET analysis. V.L. Murthy declares research support from INVIA, LLC, and stock interest in General Electric, Mallinckrodt, Cardinal Health.

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Author notes

  1. Venkatesh L. Murthy and Edward P. Ficaro have contributed equally and also as co-senior authors.

Authors and Affiliations

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

    Jonathan B. Moody PhD, Benjamin C. Lee PhD, Alexis Poitrasson-Rivière PhD & Edward P. Ficaro PhD

  2. Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA

    Keri M. Hiller CNMT, RT(N), James R. Corbett MD, Richard L. Weinberg MD, Venkatesh L. Murthy MD, PhD & Edward P. Ficaro PhD

  3. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    James R. Corbett MD, Richard L. Weinberg MD & Venkatesh L. Murthy MD, PhD

  4. Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    James R. Corbett MD, Richard L. Weinberg MD, Venkatesh L. Murthy MD, PhD & Edward P. Ficaro PhD

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  1. Jonathan B. Moody PhD
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JNC thanks Erick Alexanderson MD, Alondra Flores MD, Jessy Steve Masso MD, and Oscar Perez-Orpinel MD for providing the Spanish abstract; Zhuo He, Haipeng Tang MS, Min Zhao, and Weihua Zhou PhD for providing the Chinese abstract; and Jean-Luc Urbain, MD, PhD, CPE, Past President CANM, Chief Nuclear Medicine, Lebanon VAMC, PA for providing the French abstract.

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Moody, J.B., Hiller, K.M., Lee, B.C. et al. The utility of 82Rb PET for myocardial viability assessment: Comparison with perfusion-metabolism 82Rb-18F-FDG PET. J. Nucl. Cardiol. 26, 374–386 (2019). https://doi.org/10.1007/s12350-019-01615-0

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