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Quantitative myocardial perfusion 82Rb-PET assessed by hybrid PET/coronary-CT: Normal values and diagnostic performance

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Purpose

We aimed to assess normal values for quantified myocardial blood flow (MBF) on a hybrid PET/coronary-CT scanner and to test their diagnostic performance in patients with suspected CAD.

Materials and Methods

Patients underwent 82Rb-PET/CT and integrated CT-based coronary angiography (CCTA) and were classified as normal (no stenosis), with non-obstructive stenosis (< 50%) and with CAD (≥ 50%). Global and regional stress MBF (sMBF), rest MBF and myocardial flow reserve (MFR) were calculated. Ischemia was defined as SDS ≥ 2, severe ischemia as SDS ≥ 7.

Results

357 consecutive patients were included. Global sMBF and MFR were higher in normal patients than in patients with CAD (3.61 ± 0.71 vs 3.04 ± 0.77, P < 0.0001; 3.08 ± 0.84 vs 2.68 ± 0.79, P = 0.0001), but not different compared to patients with non-obstructive stenosis (3.61 ± 0.71 vs 3.43 ± 0.69, P = 0.052; 3.08 ± 0.84 vs 2.99 ± 0.82, P = 0.45). sMBF yielded superior accuracy over MFR in identifying both ischemia (AUC 0.74 vs 0.62, P = 0.003) and severe ischemia (AUC 0.88 vs 0.78, P = 0.012). Optimal threshold for global sMBF to rule out myocardial ischemia was 3.5 mL g−1 min−1.

Conclusions

Normal quantitative values are provided. Global sMBF provided higher diagnostic accuracy than MFR. Using sMBF-threshold of 3.5 mL·g−1·min−1 on 82Rb-PET/CT yielded similar NPV (96%) as CCTA to rule out CAD. Hence, resting scan could be omitted in patients with sMBF values above reference.

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Abbreviations

CCTA:

CT-based coronary angiography

LAD:

Left anterior descending artery

RCA:

Right coronary artery

RCX:

Ramus circumflexus (left circumflex artery)

sMBF:

Stress myocardial blood flow

rMBF:

Rest myocardial blood flow

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

PPV/NPV:

Positive/negative predictive value

SRS/SSS/SDS:

Summed rest/stress/difference score

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Acknowledgements

We greatly appreciate the help and assistance of our excellent technicians.

Disclosure

Martin T. Freitag, Jens Bremerich, Damian Wild, Philip Haaf and Michael Zellweger report no disclosures relevant to the manuscript. Federico Caobelli received academic grant support from GE Healthcare and Tillots AG and speaker honoraria from Siemens, for matters not related to the current study. All the authors declared no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. A formal approval from the local Ethical Board was obtained for the present study (Req-2019-00447).

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Authors and Affiliations

  1. Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Martin T. Freitag MD, Jens Bremerich MD, Damian Wild MD & Federico Caobelli MD, FEBNM

  2. Clinic of Cardiology, University Hospital Basel, Basel, Switzerland

    Philip Haaf MD & Michael J. Zellweger MD

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  1. Martin T. Freitag MD
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  2. Jens Bremerich MD
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  3. Damian Wild MD
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  5. Michael J. Zellweger MD
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  6. Federico Caobelli MD, FEBNM
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Correspondence to Federico Caobelli MD, FEBNM.

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Freitag, M.T., Bremerich, J., Wild, D. et al. Quantitative myocardial perfusion 82Rb-PET assessed by hybrid PET/coronary-CT: Normal values and diagnostic performance. J. Nucl. Cardiol. 29, 464–473 (2022). https://doi.org/10.1007/s12350-020-02264-4

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  • DOI: https://doi.org/10.1007/s12350-020-02264-4

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