Accuracy of low-dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and normal database interpretation

doi:10.1007/s12350-012-9621-y

Journal of Nuclear Cardiology

Volume 19, Issue 6, December 2012, Pages 1135-1145

https://doi.org/10.1007/s12350-012-9621-y Get rights and content

Abstract

Background

Our aim was to develop a normal database to be used for quantification of myocardial perfusion and diagnosis of “obstructive coronary artery disease” (CAD) using low-dose rubidium-82 three-dimensional (3D) positron emission tomography (PET)-CT.

Methods

From a record of 1,501 patients, 77 were identified as having low-likelihood (LLK) of CAD. Forty LLK patients were used to construct a normal database using 4DM-PET, the remainder used for validation of normalcy. A group of 70 patients with CAD who had invasive coronary angiography and PET-CT were used to evaluate the accuracy of the database for detecting CAD using the sum-stress-score. The effect of clinical exclusion criteria and the inclusion of LLK patients were evaluated.

Results

The normal database for CAD detection had a normalcy rate of 95%. Sensitivity was 100% for detecting patients with either 50% or 70% stenosis. Optimal specificity was 87% for either 50% or 70% stenosis. For localizing disease at 50% stenosis in the left anterior descending, left circumflex, and right coronary artery, sensitivity ranged from 59% to 68%, while specificity was maintained at 87-89%. Similarly, at 70% stenosis, sensitivity ranged from 64% to 79%, and specificity from 87% to 91%.

Conclusions

A normal database containing the relative perfusion scores of patients with LLK of CAD can be used to accurately diagnose obstructive coronary disease using low-dose Rb-82 with 3D PET-CT imaging.

Introduction

Myocardial perfusion imaging using Rb-82 positron emission tomography (PET) is a powerful tool for diagnosing obstructive coronary artery disease (CAD) because of its consistently high accuracy.1, 2, 3, 4, 5, 6 Technological improvements are incrementally improving the diagnostic ability of PET systems, such as three-dimensional (3D) coincidence detection. 3D PET imaging poses a challenge because of increased scatter; however, this can be outweighed by advantages from the increased sensitivity and count density, which results in improved image quality and reduced patient doses.7, 8, 9

Previous studies have described the development of “normal databases” characterizing relative perfusion data for patients with a low-likelihood (LLK) of CAD.²,⁶,10, 11, 12, 13 These databases objectively define the normal range of relative perfusion values to evaluate patients with suspected CAD and determine whether the perfusion distribution is normal or abnormal. These databases can be used as an adjunct to the subjective visual scan interpretation by the clinician. Most of the previous studies that have developed LLK normal databases have done so only in the context of SPECT or 2D PET myocardial perfusion imaging. There is a need for the development of additional LLK normal databases for 3D Rb-82 PET MPI. The objective of this study is to describe the development of such a database using 3D hybrid PET-CT imaging, and evaluate its accuracy for the diagnosis of CAD.

Section snippets

LLK normals

Using a record of 1,501 patients who underwent PET perfusion scans between July 2009 and December 2010 (inclusive), a group of patients with a LLK of CAD was identified. This group was created by removing any patient with the following: known CAD [i.e., previous myocardial infarction (MI), percutaneous coronary intervention (PCI), and CABG], typical or atypical angina, diabetes, and rest or stress ECG interpreted as anything other than “normal.” Contrary to Bateman et al,¹ abnormal scan

Demographics

The demographic information (self-reported) in the three patient groups is summarized in Table 1. There were no significant differences in patient characteristics between the database and validation normal groups. The angiogram patients were comparable to the normal groups in terms of age and BMI, but were significantly different (P < .05) in terms of cardiac history (MI, PCI) and several risk factors reflected in the increased Morise risk score (P < .05). The mean probability of CAD for both

Discussion

This study was performed to develop and validate a normal database for 3D PET-CT myocardial perfusion imaging with low-dose Rb-82. The normalcy rate of the database was measured using a separate validation group of 36 patients with LLK of CAD, matched to the LLK normal database group according to the Morise and Diamond-Forrester criteria (Table 1). The accuracy of this database was then determined by using patients who had had both catheterization as well as 3D PET-CT imaging performed within

Conclusion

This study demonstrates that a normal database containing the relative perfusion scores of patients without obstructive CAD can be used to accurately diagnose obstructive CAD using low-dose Rb-82 with 3D PET-CT imaging. This type of semiquantitative analysis using a normal database may be useful as an adjunct to the standard visual clinical interpretation of myocardial perfusion.

Acknowledgments

This study was supported by an operating grant from the Canadian Institute of Health Research (CIHR) for the Rb-ARMI trial (Grant MIS-100935). The study was also supported in part by the Molecular Function and Imaging (MFI) Program Grant from the Heart and Stroke Foundation of Ontario (Grant #PRG6242). R.S.B. is a Career Investigator supported by the HSFO. T.K. was supported in part by the University of Ottawa Undergraduate Research Opportunities Program. The authors would like to thank May

Disclosure

RSB and RdK are consultants with Jubilant DRAXimage and have received grant funding from a government/industry program (partners: GE Healthcare, Nordion, Lantheus Medical Imaging, DRAXimage). RdK receives revenues from rubidium generator technology licensed to Jubilant DRAXimage. RSB is a consultant for Lantheus Medical Imaging.

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Original ArticleAccuracy of low-dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and normal database interpretation

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

LLK normals

Demographics

Discussion

Conclusion

Acknowledgments

Disclosure

J Nucl Cardiol

J Nucl Cardiol

J Am Coll Cardiol

Am J Cardiol

J Nucl Cardiol

J Nucl Cardiol

Am Heart J

J Am Coll Cardiol

J Nucl Cardiol

J Nucl Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Quantitative (82)Rb PET/CT: Development and validation of myocardial perfusion database

J Nucl Med

Absolute quantification of myocardial blood flow with 13N-ammonia and 3-dimensional PET

J Nucl Med

Original Article
Accuracy of low-dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and normal database interpretation

Absolute quantification of myocardial blood flow with ¹³N-ammonia and 3-dimensional PET