Feasibility of exercise treadmill 13 N-ammonia positron emission tomography myocardial perfusion imaging using an off-si
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Advocate Aurora Health Care, Aurora Sinai/Aurora St. Luke’s Medical Centers, Milwaukee, WI Wisconsin Medical Cyclotron, West Allis, WI
Received Apr 9, 2020; accepted Aug 21, 2020 doi:10.1007/s12350-020-02366-z
Background. Myocardial perfusion imaging with treadmill exercise nitrogen-13 (13N)ammonia positron emission tomography (PET) presents a logistical challenge. We investigated the feasibility of exercise treadmill (GXT) 13N-ammonia PET MPI using an off-site cyclotron for production of 13N-ammonia. Methods. Thirty-three patients underwent GXT 13N-ammonia PET MPI over 23 months. 13 N-ammonia doses were prepared at an off-site cyclotron. Patients underwent 13N-ammonia resting and 13N-ammonia GXT emission and transmission scans at our facility. Image quality, perfusion data, and clinical variables were evaluated. Results. We analyzed 33 patients (7/26 female/male). Mean age was 63 ± 12 years and mean BMI was 33.7 ± 6.9. GXT PET was feasible in all patients. Image quality was good in 29 patients, adequate in 3, and severely compromised in 1 patient. Summed stress score was 4.5 ± 5.7. Resting and GXT left ventricular ejection fractions were 63.7 ± 10.9% and 66.3 ± 13.1%. TID ratio was 1.0 ± 0.1. Conclusions. Treadmill exercise 13N-ammonia PET is feasible in a large medical center without access to an on-site cyclotron. This technique requires close coordination with an offsite cyclotron but expands the role of PET to patients for whom exercise is more appropriate than pharmacologic stress imaging. (J Nucl Cardiol 2020) Key Words: 13N-ammonia Æ PET Æ cyclotron Æ exercise Abbreviations ALARA As low as reasonably achievable CABG Coronary artery bypass graft CAD Coronary artery disease EOS End of synthesis FFR Fractional flow reserve MPI Myocardial perfusion imaging Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02366-z) contains supplementary material, which is available to authorized users. The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. The authors have also provided two audio summaries of the article, which are available to download as ESM, or to listen to via the JNC/ ASNC Podcast.
PET SPECT GXT
Positron emission tomography Single-photon emission computed tomography Exercise treadmill test
All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Daniel S. Berman, MD. Reprint requests: Daniel R. Harland, MD, Advocate Aurora Health Care, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215; [email protected] 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Harland et al Off-site cyclotron use in tomography
INTRODUCTION Positron emission tomography (PET) myocardial perfusion imaging (MPI) has become wi
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