The imperative to assess physical function among all patients undergoing stress myocardial perfusion imaging
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Department of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and The Icahn School of Medicine at Mount Sinai, New York, NY Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham
Received Sep 4, 2020; accepted Sep 4, 2020 doi:10.1007/s12350-020-02378-9
See related article, https://doi.org/10.10 07/s12350-020-02366-z. Stress rest myocardial perfusion imaging (MPI) can be performed using either single-photon emission computed tomography (SPECT) or positron emission tomography (PET). However, PET imaging offers important advantages, including higher spatial resolution and shorter imaging protocols due to the higher photon sensitivity of PET scanners and more rapid clearance of PET radiotracers from the background, and the routine use of attenuation correction. In addition, PET-MPI allows for the absolute quantification of myocardial blood flow and assessment of coronary flow reserve. But unlike SPECT-MPI, PET-MPI is not performed in conjunction with exercise testing due to the limitations poised by current PET radiotracers. 82Rubidium, the most commonly used PET-MPI radiotracer, has a half-life of only 76 seconds. Thus, its use mandates that patients be in the PET scanner at the time of stress imaging, performed using vasodilator agents such as adenosine or regadenoson. By using 13N-ammonia with its half-life of 9.8 minutes, it is possible to use it in
Reprint requests: Alan Rozanski, MD, Department of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and The Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, New York, NY 10025; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
conjunction with exercise testing.1,2 However, exercise PET with 13N-ammonia is uncommonly performed because until now, this tracer has required an on-site cyclotron for its production and use. To-date, such onsite cyclotrons have been limited to a very small percentage of clinical imaging centers. In this issue of the Journal, Harland et al. report on their novel use of a commercial off-site cyclotron to perform exercise PET studies at their imaging center in Milwaukee WI.3 A planning tool was used on the day prior to testing to assess the optimal timing of production of 13N-ammonia, time for intended departure from the cyclotron facility, and anticipated time for delivery of the radiotracer to the hot lab of the imaging laboratory, located * 7 miles away. The estimated time for the car trip was * 20 minutes and involved the simultaneous preparation of the patient for testing once the imaging laboratory was informed that the radiotracer was on route. The investigators recruited 33 patients for this feasibility study. Most of the patients had either clinical or angiographic evidence of coronary artery disease (CAD). The study group was substantially obe
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