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Feasibility of exercise treadmill 13N-ammonia positron emission tomography myocardial perfusion imaging using an off-site cyclotron

  • ORIGINAL ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Myocardial perfusion imaging with treadmill exercise nitrogen-13 (13N)-ammonia positron emission tomography (PET) presents a logistical challenge. We investigated the feasibility of exercise treadmill (GXT) 13N-ammonia PET MPI using an off-site cyclotron for production of 13N-ammonia.

Methods

Thirty-three patients underwent GXT 13N-ammonia PET MPI over 23 months. 13N-ammonia doses were prepared at an off-site cyclotron. Patients underwent 13N-ammonia resting and 13N-ammonia GXT emission and transmission scans at our facility. Image quality, perfusion data, and clinical variables were evaluated.

Results

We analyzed 33 patients (7/26 female/male). Mean age was 63 ± 12 years and mean BMI was 33.7 ± 6.9. GXT PET was feasible in all patients. Image quality was good in 29 patients, adequate in 3, and severely compromised in 1 patient. Summed stress score was 4.5 ± 5.7. Resting and GXT left ventricular ejection fractions were 63.7 ± 10.9% and 66.3 ± 13.1%. TID ratio was 1.0 ± 0.1.

Conclusions

Treadmill exercise 13N-ammonia PET is feasible in a large medical center without access to an on-site cyclotron. This technique requires close coordination with an off-site cyclotron but expands the role of PET to patients for whom exercise is more appropriate than pharmacologic stress imaging.

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Abbreviations

ALARA:

As low as reasonably achievable

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

EOS:

End of synthesis

FFR:

Fractional flow reserve

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

SPECT:

Single-photon emission computed tomography

GXT:

Exercise treadmill test

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Acknowledgements

The authors gratefully acknowledge from Aurora Cardiovascular and Thoracic Services Susan Nord and Jennifer Pfaff for editorial preparation of the manuscript and Brian Miller and Brian Schurrer for their help with the figures.

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Advocate Aurora Health Care, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA

    Daniel R. Harland MD, Patrycja Z. Galazka MD, Debra Mahlum BS, Janelle Falk BS & Steven C. Port MD

  2. Wisconsin Medical Cyclotron, West Allis, WI, USA

    Jerry Rasmussen BSEE

Authors
  1. Daniel R. Harland MD
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  2. Patrycja Z. Galazka MD
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  3. Jerry Rasmussen BSEE
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  4. Debra Mahlum BS
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  5. Janelle Falk BS
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  6. Steven C. Port MD
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Correspondence to Daniel R. Harland MD.

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Harland, D.R., Galazka, P.Z., Rasmussen, J. et al. Feasibility of exercise treadmill 13N-ammonia positron emission tomography myocardial perfusion imaging using an off-site cyclotron. J. Nucl. Cardiol. 29, 938–945 (2022). https://doi.org/10.1007/s12350-020-02366-z

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