Consistent tracer administration profile improves test-retest repeatability of myocardial blood flow quantification with 82Rb dynamic PET imaging

J Nucl Cardiol. 2018 Jun;25(3):929-941. doi: 10.1007/s12350-016-0698-6.

Abstract

Objectives: Quantification of myocardial blood flow (MBF) and stress/rest flow reserve is used increasingly to diagnose multi-vessel coronary artery disease and micro-vascular disease with PET imaging. However, variability in the measurements may limit physician confidence to direct revascularization therapies based on specific threshold values. This study evaluated the effects of rubidium-82 (82Rb) tracer injection profile using a constant-activity-rate (CA) vs a constant-flow-rate (CF) infusion to improve test-retest repeatability of MBF measurements.

Method: 22 participants underwent single-session 82Rb dynamic PET imaging during rest and dipyridamole stress using one of 2 test-retest infusion protocols: CA-CA (n = 12) or CA-CF (n = 10). MBF was quantified using a single-tissue-compartment model (1TCM) and a simplified retention model (SRM). Non-parametric test-retest repeatability coefficients (RPCnp) were compared between groups. Myocardium-to-blood contrast and signal-to-noise ratios of the late uptake images (2 to 6 minutes) were also compared to evaluate standard myocardial perfusion image (MPI) quality.

Results: MBF values in the CA-CA group were more repeatable (smaller RPCnp) than the CA-CF group using the 1TCM at rest alone, rest and stress combined, and stress/rest reserve (21% vs 36%, 16% vs 19%, and 20% vs 27%, P < 0.05, respectively), and using the SRM at Rest and Stress alone, Rest and Stress combined, and stress/rest reserve (21% vs 38%, 15% vs 25%, 22% vs 38%, and 23% vs 49%, P < 0.05, respectively). In terms of image quality, myocardium-to-blood contrast and signal-to-noise ratios were not significantly different between groups.

Conclusions: Constant-activity-rate 'square-wave' infusion of 82Rb produces more repeatable tracer injection profiles and decreases the test-retest variability of MBF measurements, when compared to a constant-flow-rate 'bolus' administration of 82Rb, especially with SRM, and without compromising standard MPI quality.

Keywords: Rubidium-82; myocardial blood flow; reproducibility; square-wave infusion profile.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cohort Studies
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / physiopathology
  • Coronary Circulation
  • Dipyridamole
  • Exercise Test
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Perfusion Imaging / methods*
  • Positron-Emission Tomography / methods*
  • Radiopharmaceuticals / administration & dosage*
  • Reproducibility of Results
  • Rubidium Radioisotopes / administration & dosage*
  • Vasodilator Agents

Substances

  • Radiopharmaceuticals
  • Rubidium Radioisotopes
  • Vasodilator Agents
  • Dipyridamole
  • Rubidium-82