Research ArticleClinical Investigations

Comparison of Clinical Tools for Measurements of Regional Stress and Rest Myocardial Blood Flow Assessed with 13N-Ammonia PET/CT

Piotr J. Slomka, Erick Alexanderson, Rodrigo Jácome, Moises Jiménez, Edgar Romero, Aloha Meave, Ludovic Le Meunier, Magnus Dalhbom, Daniel S. Berman, Guido Germano and Heinrich Schelbert
Journal of Nuclear Medicine February 2012, 53 (2) 171-181; DOI: https://doi.org/10.2967/jnumed.111.095398

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Linear regression (left) and Bland–Altman (right) plots for QPET vs. syngo MBF, QPET vs. PMOD, and syngo MBF vs. QPET for flow values combining stress and rest values (n = 66). C = QPET; P = PMOD; S = syngo MBF.

  • FIGURE 2.
    FIGURE 2.

    Linear regression (left) and Bland–Altman (right) plots for QPET vs. syngo MBF, QPET vs. PMOD, and syngo MBF vs. QPET for flow values combining stress and rest values (n = 61) after excluding 5 cases with high spillover fraction (>0.65) (n = 61). C = QPET; P = PMOD; S = syngo MBF.

  • FIGURE 3.
    FIGURE 3.

    MFR. Linear regression (left) and Bland–Altman (right) plots for QPET vs. syngo MBF, QPET vs. PMOD, and PMOD vs. syngo MBF (n = 29). C = QPET; P = PMOD; S = syngo MBF.

  • FIGURE 4.
    FIGURE 4.

    Regional flow regression plots among the 3 methods (n = 61). All flow values are reported in mL/g/min. C = QPET; P = PMOD; S = syngo MBF.

  • FIGURE 5.
    FIGURE 5.

    Mean regional stress and rest flow MBF (A) and MFR (B) results obtained in very low likelihood and ischemic patient groups by the 3 methods. None of the results were significantly different from one another (1-way ANOVA of repeated measures) in either very low likelihood or ischemic group.

  • FIGURE 6.
    FIGURE 6.

    Example output generated by QPET (top left), PMOD (top right), and syngo MBF (bottom) in 65-y-old man. All 3 methods demonstrated abnormal MFR (QPET: stress flow = 1.20 mL/g/s, rest flow = 0.96 mL/g/s, MFR = 1.29; syngo MBF: stress flow = 1.23 mL/g/min, rest flow = 0.89 mL/g/min, MFR = 1.42; PMOD: stress flow = 1.42 mL/g/min, rest flow = 0.84 mL/g/min, MFR = 1.68).

Tables

  • TABLE 1

    Patient Characteristics (n = 33)

    CharacteristicValue
    Men (n)22 (66%)
    Mean age ± SD (y)54.6 ± 14.6
    Mean body mass index ± SD26.4 ± 4.0
    Patients with diabetes (n)5
    Patients with hypertension (n)16
    Patients with dyslipidemia (n)18
    Smokers (n)14
    Patients with a family history (n)13
    Patients with myocardial infarction (n)9
    Very low likelihood patients (n)18
  • TABLE 2

    Hemodynamics in Patients

    CharacteristicValue
    Rest
     Heart rate (beats/min)67.2 ± 11.0
     Systolic blood pressure (mm Hg)124.0 ± 14.9
     RPP (beats/min · mm Hg)8,405.6 ± 2,095.9
    Stress
     Heart rate (beats/min)78.9 ± 18.1
     Systolic blood pressure (mm Hg)124.2 ± 18.1
     RPP (beats/min · mm Hg)9,790.7 ± 2,679.9

    • RPP = rate–pressure product.

  • TABLE 3

    Regression R2 and SE Among the 3 Methods When Cases with High Spillover Fraction Are Excluded

    R2SE
    Spillover fraction thresholdNQPET vs. syngo MBFQPET vs. PMODQPET vs. syngo MBFQPET vs. PMOD
    All660.900.880.3460.368
    <0.70640.920.910.3070.319
    <0.65610.950.920.2500.311
    <0.60560.960.920.2220.305
    <0.5430.950.930.2300.274

    • N = number of cases with spillover fraction below the given threshold.

  • TABLE 4

    Mean Absolute Differences (±SD) Between Measurements Obtained by the 3 Methods

    ComparisonRest flow (mL/g/min)Stress flow (mL/g/min)MFR
    QPET vs. syngo MBF0.09 ± 0.060.28 ± 0.220.44 ± 0.42
    PMOD vs. syngo MBF0.11 ± 0.080.30 ± 0.220.58 ± 0.50
    QPET vs. PMOD0.11 ± 0.080.39 ± 0.270.49 ± 0.44
  • TABLE 5

    R2, SE, Interobserver Reproducibility, and 95% Confidence Interval (CI) for the 3 Methods

    Flow (mL/g/min)MFR
    MethodR2SEBiasCIR2SEBiasCI
    QPET0.990.09−0.04−0.26, −0.190.970.20−0.06−0.43, −0.31
    Syngo MBF0.990.120.04−0.2, 0.270.910.290.19−0.38, 0.76
    PMOD0.990.100.03−0.16, 0.220.940.23−0.07−0.56, 0.42
  • TABLE 6

    Stress and Rest Flow and MFR Results Obtained in Very Low Likelihood and Ischemic Patients by the 3 Methods

    GroupStress flow (mL/g/min)Rest flow (mL/g/min)MFR
    Very low likelihood (n = 15)
     QPET3.00 ± 0.66 (1.97–4.21)0.87 ± 0.24 (0.59–1.25)3.66 ± 1.19 (2.25–6.63)
     Syngo MBF2.89 ± 0.45 (2.29–3.60)0.90 ± 0.20 (0.68–1.33)3.41 ± 0.76 (2.13–4.83)
     PMOD2.77 ± 0.65 (1.92–4.34)0.85 ± 0.16 (0.69–1.40)3.39 ± 1.22 (2.23–6.82)
    Ischemic (n = 14)
     QPET2.04 ± 0.80 (0.90–3.60)0.78 ± 0.24 (0.51–1.32)2.71 ± 1.00 (1.27–3.76)
     Syngo MBF1.98 ± 0.66 (0.88–3.07)0.74 ± 0.21 (0.42–1.09)2.90 ± 1.17 (1.33–4.51)
     PMOD1.83 ± 0.57 (1.16–3.02)0.77 ± 0.23 (0.40–1.42)2.51 ± 0.74 (1.41–3.76)

    • Data are mean ± SD, with ranges in brackets.

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Bookmark this article

Jump to section

Related Articles

Cited By...

More in this TOC Section

Similar Articles