Sub-endocardial and sub-epicardial measurement of myocardial blood flow using 13 NH 3 PET in man
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Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ‘‘Mario Serio’’, University of Florence, Florence, Italy Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, TV, Italy Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Brescia, Italy PMOD Technologies LLC, Zurich, Switzerland Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
Received Jun 29, 2018; accepted Sep 5, 2018 doi:10.1007/s12350-018-1445-y
Background. This study examined whether measuring myocardial blood flow (MBF) in the sub-endocardial (SEN) and sub-epicardial (SEP) layers of the left ventricular myocardium using 13NH3 positron emission tomography (PET) and an automated procedure gives reasonable results in patients with known or suspected coronary artery disease (CAD). Methods. Resting and stress 13NH3 dynamic PET were performed in 70 patients. Using ‡ 70% diameter stenosis in invasive coronary angiography (ICA) to identify significant CAD, we examined the diagnostic value of SEN- and SEP-MBF, and coronary flow reserve (CFR) vs. the corresponding conventional data averaged on the whole wall thickness. Results. ICA demonstrated 36 patients with significant CAD. Their global stress average [1.61 (1.26, 1.87) mLmin21g21], SEN [1.39 (1.2, 1.59) mLmin21g21] and SEP [1.22 (0.96, 1.44) mLmin21g21] MBF were significantly lower than in the 34 no-CAD patients: 2.05 (1.76, 2.52), 1.72 (1.53, 1.89) and 1.46 (1.23, 1.89) mLmin21g21, respectively, all P < .005. In the 60 CAD vs. the 150 non-CAD territories, stress average MBF was 1.52 (1.10, 1.83) vs. 2.06 (1.69, 2.48) mLmin21g21, SEN-MBF 1.33 (1.02, 1.58) vs. 1.66 (1.35, 1.93) mLmin21g21, and SEPMBF 1.07 (0.80, 1.29) vs. 1.40 (1.12, 1.69) mLmin21g21, respectively, all P < .05. Using receiver operating characteristics analysis for the presence of significant CAD, the areas under the curve (AUC) were all significant (P < .0001 vs. AUC = 0.5) and similar: stress average MBF = 0.79, SEN-MBF = 0.75, and SEP-MBF = 0.73. AUC was 0.77 for the average CFR, 0.75 for SEN, and 0.70 for SEP CFR. The stress transmural perfusion gradient (TPG) AUC (0.51) was not significant. However, stress TPG was significantly lower in segments subtended by
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-018-1445-y) 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 summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. Funding This work was supported by the Italian Ministry of Health (RF 2010-2313451 and NET-2011-02347173).
Reprint requests: Roberto Sciagra´, MD, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Largo Br
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