Assessment of myocardial perfusion by dynamic O-15–labeled water PET imaging: Validation of a new fast factor analysis

doi:10.1016/j.nuclcard.2007.05.012

Journal of Nuclear Cardiology

Volume 14, Issue 5, September–October 2007, Pages 698-705

https://doi.org/10.1016/j.nuclcard.2007.05.012 Get rights and content

Background

Factor analysis (FA) is an established method for separating myocardium from blood pool by use of oxygen 15–labeled water and positron emission tomography for analyzing myocardial blood flow (MBF). Conventional FA methods generating images from sinograms (sinoFA) are time-consuming, whereas FA can be performed on the reconstructed images (reconFA) in a fraction of time. We validated the MBF values obtained by reconFA versus sinoFA.

Methods and Results

In 23 volunteers (mean age, 26.6 ± 3.4 years) MBF was calculated from sinoFA and reconFA and blindly reanalyzed 1 month later by the same observer. Intraobserver agreement and reconFA-versus-sinoFA agreement were assessed according to Bland and Altman (BA). Reproducibility proved excellent for global sinoFA (r = 0.968; P < .001; BA limits, −0.617 to 0.676 mL · min⁻¹ · g⁻¹) and slightly superior for reconFA (r = 0.979; P < .001; BA limits, −0.538 to 0.558 mL · min⁻¹ · g⁻¹), with wider limits of agreement for segmental MBF from sinoFA (r = 0.777; P < .001; BA limits, −1.676 to 1.656 mL · min⁻¹ · g⁻¹) and reconFA (r = 0.844; P < .001; BA limits, −1.999 to 1.992 mL · min⁻¹ · g⁻¹). In addition, sinoFA and reconFA showed excellent correlation (r = 0.975, P < .001) and agreement (BA limits, −0.528 to 0.648 mL · min⁻¹ · g⁻¹) for global and segmental values (r = 0.955; P < .001; BA limits, −1.371 to 1.491 mL · min⁻¹ · g⁻¹).

Conclusions

Use of reconFA allows rapid and reliable quantitative MBF assessment with O-15–labeled water.

Section snippets

Study population

We consecutively enrolled 23 healthy volunteers (17 men and 6 women; mean age, 26.6 ± 3.4 years) in our study. This group was chosen because the incidence of coronary artery disease (CAD) increases sharply beyond 50 years of age.¹² None of the volunteers had a history of a prior cardiac event or elevated total or low-density lipoprotein cholesterol levels, hypertension, or diabetes mellitus. The inclusion criteria were normal resting electrocardiogram, normal heart rate, normal blood pressure,

Results

All rest and adenosine stress procedures were well tolerated, and no subjects were withdrawn from the analysis. None of the subjects had any significant electrocardiographic changes or intolerable alterations of blood pressure.

Discussion

This study confirms an excellent agreement of MBF assessed with O-15–labeled water and PET via both methods for FA (ie, reconFA and sinoFA). The validity and reliability of reconFA are further substantiated by its high intraobserver reproducibility, which was slightly superior than that for sinoFA. This equally applies to global and segmental MBF estimates.

The use of factor images has been introduced into nuclear cardiology by Hermansen et al,⁹ and its reproducibility for assessing MBF has been

Conclusions

Our results suggest that reconFA should be used for quantitative MBF measurement with O-15–labeled water and PET, as it considerably shortens analysis time and provides accurate values as compared with the validated sinoFA method. Its reliability is further substantiated by the excellent reproducibility, which is slightly superior to that for sinoFA.

Acknowledgment

We are grateful to Ratko Milovanovic, deputy chief radiographer, for his excellent technical support.

The authors have indicated they have no financial conflicts of interest.

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Positron emission tomography (PET) is a radionuclide imaging technique that allows for noninvasive quantification of biochemical pathways in vivo. Utilizing positron emitting labelled compounds of interest, a myriad of biological processes can be visualized in the human heart. As such, PET has been proven invaluable to the noninvasive investigation of cardiovascular biology and physiology. Assessment of myocardial perfusion and substrate metabolism are of particular value in the evaluation of patients with (suspected) coronary artery disease (CAD) to detect ischemia and myocardial viability. This chapter will outline the fundamental principles of PET and technical considerations of cardiac PET imaging.
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Static 15O-water images of the myocardium, on the other hand, are commonly of lower count density due to subtraction of the blood pool from the 15O-water images, rapid clearance of 15O-water and its short half-life. Such low count 15O-water images are not suitable for the visual analysis of relative radiotracer uptake of the LV and, thus, they are not used clinically for CAD detection.9 Interestingly, in order to overcome the latter limitation of static 15O-water images, parametric mapping of hyperemic MBF and MFR values, as determined with 15O-water PET, has been developed42–44 and applied in the clinical setting (Fig 3A).1,2,45
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PET approaches for the assessment of regional MBF in ml/g/min entails the intravenous injection of a positron-emitting perfusion tracer, such as 13N-ammonia, 15O-water, or 82Rubidium, and dynamic acquisition of images of the radiotracer passing through the central circulatory system to its extraction and retention in the left ventricular myocardium (Table 1) (19,22,23).
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: This study was supported by a grant from the Swiss National Science Foundation (professorship grant PP00A-114706).

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Original articleAssessment of myocardial perfusion by dynamic O-15–labeled water PET imaging: Validation of a new fast factor analysis

Background

Methods and Results

Conclusions

Section snippets

Study population

Results

Discussion

Conclusions

Acknowledgment

J Nucl Cardiol

Quantification of regional myocardial blood flow in vivo with H215O

Circulation

Characterization of the functional significance of subcritical coronary stenoses with H(2)15O and positron-emission tomography

Circulation

Generation of parametric image of regional myocardial blood flow using H(2)(15)O dynamic PET and a linear least-squares method

J Nucl Med

Smoking cessation normalizes coronary endothelial vasomotor response assessed with 15O-water and PET in healthy young smokers

J Nucl Med

Measurement of local contribution within the brain by means of inert, diffusible tracers: examination of the theory, assumptions and possible sources of error

Acta Neurol Scand

Noninvasive quantification of regional myocardial blood flow in coronary artery disease with oxygen-15-labeled carbon dioxide inhalation and positron emission tomography

Circulation

Measurement of absolute myocardial blood flow with H215O and dynamic positron-emission tomographyStrategy for quantification in relation to the partial-volume effect

Circulation

Improvement of algorithm for quantification of regional myocardial blood flow using 15O-water with PET

J Nucl Med

Generation of myocardial factor images directly from the dynamic oxygen-15-water scan without use of an oxygen-15-carbon monoxide blood-pool scan

J Nucl Med

Parametric imaging of myocardial blood flow with 15O-water and PET using the basis function method

J Nucl Med

Validation of myocardial perfusion reserve measurements using regularized factor images of H(2)(15)O dynamic PET scans

J Nucl Med

Original article
Assessment of myocardial perfusion by dynamic O-15–labeled water PET imaging: Validation of a new fast factor analysis