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