Assessment of resting myocardial blood flow in regions of known transmural scar to confirm accuracy and precision of 3D cardiac positron emission tomography

Robert M Bober; Richard V Milani; Sergey M Kachur; Daniel P Morin

doi:10.1186/s13550-023-01037-7

Assessment of resting myocardial blood flow in regions of known transmural scar to confirm accuracy and precision of 3D cardiac positron emission tomography

EJNMMI Res. 2023 Sep 27;13(1):87. doi: 10.1186/s13550-023-01037-7.

Authors

Robert M Bober^{1

2}, Richard V Milani^{3

4}, Sergey M Kachur³, Daniel P Morin^{3

4}

Affiliations

¹ Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA. rbober@ochsner.org.
² Ochsner Clinical School, Queensland University School of Medicine, New Orleans, LA, USA. rbober@ochsner.org.
³ Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA.
⁴ Ochsner Clinical School, Queensland University School of Medicine, New Orleans, LA, USA.

Abstract

Background: Composite invasive and non-invasive data consistently demonstrate that resting myocardial blood flow (rMBF) in regions of known transmural myocardial scar (TMS) converge on a value of ~ 0.30 mL/min/g or lower. This value has been confirmed using the 3 most common myocardial perfusion agents (¹³N, ¹⁵O-H₂O and ⁸²Rb) incorporating various kinetic models on older 2D positron emission tomography (PET) systems. Thus, rMBF in regions of TMS can serve as a reference "truth" to evaluate low-end accuracy of various PET systems and software packages (SWPs). Using ⁸²Rb on a contemporary 3D-PET-CT system, we sought to determine whether currently available SWP can accurately and precisely measure rMBF in regions of known TMS.

Results: Median rMBF (in mL/min/g) and COV in regions of TMS were 0.71 [IQR 0.52-1.02] and 0.16 with 4DM; 0.41 [0.34-0.54] and 0.10 with 4DM-FVD; 0.66 [0.51-0.85] and 0.11 with Cedars; 0.51 [0.43-0.61] and 0.08 with Emory-Votaw; 0.37 [0.30-0.42], 0.07 with Emory-Ottawa, and 0.26 [0.23-0.32], COV 0.07 with HeartSee.

Conclusions: SWPs varied widely in low end accuracy based on measurement of rMBF in regions of known TMS. 3D PET using ⁸²Rb and HeartSee software accurately (0.26 mL/min/g, consistent with established values) and precisely (COV = 0.07) quantified rMBF in regions of TMS. The Emory-Ottawa software yielded the next-best accuracy (0.37 mL/min/g), though rMBF was higher than established gold-standard values in ~ 5% of the resting scans. 4DM, 4DM-FDV, Cedars and Emory-Votaw SWP consistently resulted values higher than the established gold standard (0.71, 0.41, 0.66, 0.51 mL/min/g, respectively), with higher interscan variability (0.16, 0.11, 0.11, and 0.09, respectively).

Trial registration: clinicaltrial.gov, NCT05286593, Registered December 28, 2021, https://clinicaltrials.gov/ct2/show/NCT05286593 .

Keywords: Myocardial scar; Positron emission tomography (PET); Resting myocardial blood flow.

Associated data

ClinicalTrials.gov/NCT05286593

Grants and funding

IIS-US-0147/Bracco Diagnostics