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Coronary Flow and Flow Reserve by PET Simplified for Clinical Applications Using Rubidium-82 or Nitrogen-13-Ammonia

Diagnostic Imaging Research, National Institute of Radiological Sciences, Chiba, Japan
Positron Diagnostic Research Center and Division of Cardiology, Department of Medicine, University of Texas Medical School, Houston, Texas

Correspondence: For correspondence or reprints contact: K. Lance Gould, MD, Professor of Medicine, University of Texas Medical School, MSB 4.258, 6431 Fannin St., Houston, TX 77030.

ABSTRACT

To validate routine, noninvasive determination of absolute myocardial perfusion and coronary flow reserve (CFR), cardiac PET was performed in animals using a simplified imaging protocol, high-dose dipyridamole and a simplified quantitative algorithm specific for ⁸²Rb and ¹³N-ammonia. Methods: One hundred thirty-five PET scans were obtained in eight dogs after intravenous ¹³N-ammonia or ⁸²Rb using serial dynamic PET or a simple two-image dataset. A simple flow model using the two-image dataset was developed for each radionuclide to account for varying arterial input function, flow-dependent myocardial extraction and increased permeability surface area (PS) product due to capillary recruitment at high flows not incorporated into previous models. Myocardial perfusion by the simple model was compared to standard, complete, two-compartment kinetic models validated by comparison to electromagnetic flow meter. Results: For ¹³N-ammonia, myocardial perfusion by the simple PET model correlated with that by complete compartmental analysis of multiple serial PET images with r = 0.94, slope = 0.96; CFR by compartmental analysis correlated with CFR by electromagnetic flow meter with r = 0.94, slope = 0.97. For ⁸²Rb, myocardial perfusion determined by the simple model correlated with that determined by complete compartmental analysis of multiple serial PET images with r = 0.98, slope = 1.06; CFR determined by compartmental analysis correlated with CFR by electromagnetic flow meter with r = 0.88, slope = 1.13. Conclusion: A simplified PET protocol using ¹³N-ammonia or ⁸²Rb and simple flow models provide noninvasive measurement of CFR up to six times baseline flow throughout the heart and diagnostic image quality for routine clinical application.

Key Words: PET • rubidium-82 • nitrogen-13-ammonia • coronary flow reserve

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