Combining dynamic and ECG-gated 82Rb-PET for practical implementation in the clinic

ObjectivesFor many cardiac clinics, list-mode PET is impractical. Therefore, separate dynamic and ECG-gated acquisitions are needed to detect harmful stenoses, indicate affected coronary arteries, and estimate stenosis severity. However, physicians usually order gated studies only because of dose, time, and cost limitations. These gated studies are limited to detection. In an effort to remove these limitations, we developed a novel curve-fitting algorithm [incomplete data (ICD)] to accurately calculate coronary flow reserve (CFR) from a combined dynamic-ECG protocol of a length equal to a typical gated scan. MethodsWe selected several retrospective dynamic studies to simulate shortened dynamic acquisitions of the combined protocol and compared (a) the accuracy of ICD and a nominal method in extrapolating the complete functional form of arterial input functions (AIFs); and (b) the accuracy of ICD and ICD-AP (ICD with a-posteriori knowledge of complete-data AIFs) in predicting CFRs. ResultsAccording to the Akaike information criterion, AIFs predicted by ICD were more accurate than those predicted by the nominal method in 11 out of 12 studies. CFRs predicted by ICD and ICD-AP were similar to complete-data predictions (PICD=0.94 and PICD-AP=0.91) and had similar average errors (eICD=2.82% and eICD-AP=2.79%). ConclusionAccording to a nuclear cardiologist and an expert analyst of PET data, both ICD and ICD-AP predicted CFR values with sufficient accuracy for the clinic. Therefore, by using our method, physicians in cardiac clinics would have access to the necessary amount of information to differentiate between single-vessel and triple-vessel disease for treatment decision making.

[1]  Thomas P. Ryan,et al.  Modern Regression Methods , 1996 .

[2]  Ran Klein,et al.  Quantification of myocardial blood flow with 82Rb dynamic PET imaging , 2007, European Journal of Nuclear Medicine and Molecular Imaging.

[3]  Sharmila Dorbala,et al.  Cardiac PET-CT , 2007, Journal of thoracic imaging.

[4]  G Maurer,et al.  Myocardial perfusion in patients with typical chest pain and normal angiogram , 2006, European journal of clinical investigation.

[5]  Raymond F Muzic,et al.  Evaluation of objective functions for estimation of kinetic parameters. , 2006, Medical physics.

[6]  D. Levy,et al.  Prediction of coronary heart disease using risk factor categories. , 1998, Circulation.

[7]  Timothy J Gardner,et al.  ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). , 2004, Circulation.

[8]  Mark Muzi,et al.  Kinetic Analysis of 18F-Fluoride PET Images of Breast Cancer Bone Metastases , 2010, Journal of Nuclear Medicine.

[9]  S. Moore,et al.  Clinical Myocardial Perfusion PET/CT* , 2007, Journal of Nuclear Medicine.

[10]  J. Doye,et al.  Global Optimization by Basin-Hopping and the Lowest Energy Structures of Lennard-Jones Clusters Containing up to 110 Atoms , 1997, cond-mat/9803344.

[11]  M. Wernick,et al.  Emission Tomography: The Fundamentals of PET and SPECT , 2004 .

[12]  Mark T Madsen,et al.  EMISSION TOMOGRAPHY: THE FUNDAMENTALS OF PET AND SPECT , 2005 .

[13]  C. Pirich,et al.  Cardiac PET-CT and its Implementation into Clinical Practice , 2008 .

[14]  D. Ruppert,et al.  Transformation and Weighting in Regression , 1988 .

[15]  D. Feng,et al.  Models for computer simulation studies of input functions for tracer kinetic modeling with positron emission tomography. , 1993, International journal of bio-medical computing.

[16]  J. Ornato,et al.  ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). , 2004, Circulation.

[17]  Scott Kirkpatrick,et al.  Optimization by simulated annealing: Quantitative studies , 1984 .

[18]  H. J. Lamb,et al.  Diagnostic and prognostic value of non-invasive imaging in known or suspected coronary artery disease , 2005, European Journal of Nuclear Medicine and Molecular Imaging.

[19]  Stefan Eberl,et al.  Evaluation of two population-based input functions for quantitative neurological FDG PET studies , 1997, European Journal of Nuclear Medicine.

[20]  Akira Kitabatake,et al.  Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: A study using oxygen 15-labeled water PET , 2003, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[21]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. , 2002, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[22]  G. Beller,et al.  A welcomed new myocardial perfusion imaging agent for positron emission tomography. , 2009, Circulation.

[23]  Terrence D. Ruddy,et al.  Potential utility of rubidium 82 pet quantification in patients with 3-vessel coronary artery disease , 2004, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[24]  E. Wagenmakers,et al.  AIC model selection using Akaike weights , 2004, Psychonomic bulletin & review.

[25]  K. Lance Gould,et al.  Clinical cardiac PET using generator-produced Rb-82: A review , 1989, CardioVascular and Interventional Radiology.

[26]  John D Friedman,et al.  Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: Comparison with ECG-gated Tc-99m sestamibi SPECT , 2006, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[27]  Young-Hak Kim,et al.  Stents versus coronary-artery bypass grafting for left main coronary artery disease. , 2008, The New England journal of medicine.

[28]  D. Marquardt An Algorithm for Least-Squares Estimation of Nonlinear Parameters , 1963 .

[29]  O Muzik,et al.  Early Detection of Abnormal Coronary Flow Reserve in Asymptomatic Men at High Risk for Coronary Artery Disease Using Positron Emission Tomography , 1994, Circulation.