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Quantitative Evaluation of Myocardial Blood Flow and Ejection Fraction with a Single Dose of ¹³NH₃ and Gated PET

¹ PET Unit, Research Institute, Shiga Medical Center, Moriyama, Japan
² Department of Cardiology, Shiga Medical Center, Moriyama, Japan

To evaluate myocardial blood flow (MBF) and cardiac function with a single dose of ¹³NH₃, electrocardiographically (ECG) gated PET acquisition was performed after a dynamic PET scan was obtained. Gated blood-pool (GBP) imaging with C¹⁵O PET was also performed to compare the left ventricular ejection fraction (LVEF) obtained using the 2 methods. Methods: Six healthy volunteers and 34 patients with cardiovascular disease were studied. Each subject underwent dynamic PET scanning after a slow intravenous injection of approximately 740 MBq ¹³NH₃, followed by ECG gated PET scanning. MBF images were calculated by the Patlak plot method. Before obtaining the ¹³NH₃ scan, the GBP image was obtained with a bolus inhalation of C¹⁵O. Twenty patients also underwent left ventriculography (LVG) to compare the value of the LVEF obtained using this technique with that determined using the gated PET method. Results: The mean regional value of MBF calculated for healthy volunteers in the resting condition was 0.61 ± 0.10 mL/min/g. The LVEF obtained using GBP PET (EF_CO) was consistent with that obtained using LVG. The LVEF calculated from gated ¹³NH₃ scans (EF_NH3) correlated well with EF_CO, although EF_NH3 slightly underestimated the LVEF (EF_NH3 = 0.97 · EF_CO - 2.94; r = 0.87). EF_NH3 was significantly different from EF_CO in patients with a perfusion defect in the cardiac wall (EF_NH3 = 39% ± 11% vs. EF_CO = 45% ± 11%; n = 19; P < 0.001), whereas no significant difference was found between them in subjects with no defect (EF_NH3 = 58% ± 13% vs. EF_CO = 61% ± 10%; n = 21). Conclusion: Gated PET acquisition accompanied by obtaining a dynamic PET scan with a single dose of ¹³NH₃ is a promising method for the simultaneous clinical evaluation of MBF and cardiac function. However, in patients with a defect in the cardiac wall, EF_NH3 showed a tendency to underestimate the EF compared with EF_CO.

Key Words: ejection fraction • gated PET • left ventricular blood volume • myocardial blood flow • PET

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