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[1-¹¹C]Acetate as a Quantitative Perfusion Tracer in Myocardial PET

Departments of Nuclear Medicine and Cardiology, Medical School Hannover, Hannover; Department of Nuclear Medicine, Heart Center Bad Oeynhausen, University of Bochum, Bochum; and Department of Nuclear Medicine, University of Dresden, Dresden, Germany

Our objective was to investigate the properties of [1-¹¹C]acetate as a quantitative perfusion tracer for myocardial PET studies. Methods: We determined the flow dependence of the effective acetate extraction by a comparison with [¹³N]ammonia in 24 patients at rest (n = 8) and under pharmacologic vasodilation (n = 16). Furthermore, we compared the statistical quality of the perfusion values derived with both tracers. Quantification was based on an irreversible 2-compartment model for [¹³N]ammonia and a reversible 1-compartment model for [1-¹¹C]acetate. Area-conserving polar maps were used to determine the correlation between the unidirectional uptake parameters of both tracers on a pixel-by-pixel basis for the whole left ventricular myocardium. Results: A fit of a generalized Renkin–Crone formula to the data yielded the unidirectional acetate extraction fraction E(f) = 1 - 0.64e^-1.20/f. An extraction correction based on this formula led to good quantitative agreement of perfusion values derived with [¹³N]ammonia and [1-¹¹C]acetate over the whole observed flow range (average difference of flow values, 3%; correlation coefficient, 0.96). This agreement proved the applicability of acetate as a quantitative perfusion tracer even under stress conditions. An analysis of the statistical properties of the parameter estimates showed, moreover, that statistical errors were reduced by a factor of nearly 2 in comparison with ammonia. Conclusion: [1-¹¹C]acetate allows accurate quantification of myocardial perfusion with PET at rest as well as under stress conditions. The use of acetate leads to distinctly improved statistical accuracy for the perfusion estimates in comparison with ammonia. This accuracy facilitates the generation of reliable parametric polar maps, which are especially useful for clinical application of myocardial perfusion quantification.

Key Words: myocardial perfusion • acetate • extraction fraction • ammonia • PET

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