Quantification of Myocardial Blood Flow Using High-Resolution, High-Sensitivity and 214-ps SiPM⁸²Rb-PET/CT: A comparison of three software packages.

Aim: Myocardial blood flow (MBF) quantification is a promising noninvasive tool for evaluating CAD, assisting in diagnosis, treatment, and risk stratification. Several analysis software packages are validated for MBF quantification.We compared results of MBF obtained using three software packages used in clinical routine with this latest SiPM generation scanner.

Methods: In total, 111 patients (70M/41F) underwent dynamic ⁸²Rb-PET at rest and during adenosine stress on a latest generation SiPM PET/CT (Siemens Biograph Vision 600). Data were processed with: (1) Corridor4DM, (2) FlowQuant and (3) Syngo.PET MBF. MBF and myocardial flow reserve (MFR) polar maps were computed. Comparisons used Pearson’s correlation ρ (measuring precision), Bland-Altman limit-of-agreement and Lin’s concordance correlation ρ_c=ρ·C_b(C_bmeasuring systematic bias).

Results: Lin’s concordance and Pearson’s correlation values were similar, suggesting no systematic bias between Corridor4DM and FlowQuant with an excellent precision ρ for rest and stress MBF (ρ=0.717, ρ_c=0.714, C_b=0.996 and ρ=0.908, ρ_c=0.845, C_b=0.930, respectively) and for MFR (ρ=0.803, ρ_c=0.726, C_b=0.904). A good precision was measured between Corridor4DM and Syngo.PET (MBF: ρ=0.579, ρ_c=0.419, C_b=0.724 for rest and ρ=0.923, ρ_c=0.892, C_b=0.967 for stress; MFR: ρ=0.531, ρ_c=0.465, C_b=0.874) and between FlowQuant and Syngo.PET (MBF: ρ=0.676, ρ_c=0.466, C_b=0.689 for rest and ρ=0.868, ρ_c=0.851, C_b=0.980 for stress; MFR: ρ=0.624, ρ_c=0.415, C_b=0.665). Although no mean bias was observed on Bland-Altman plots, Syngo.PET provided slightly lower MFR values than FlowQuant and Corridor4DMdue to higher rest flow values.

Conclusions: Concordance between software packages was excellent for MBF and MFR, despite slightly lower values by Syngo.PET at higher MFR values. Therefore, comparison of outcomes from the three software packages assessing quantification of MBF can be applied in clinical practice.