Reproducibility of quantitative myocardial perfusion and coronary flow capacity by positron emission tomography: 3D digital silicon photomultiplier solid state vs. legacy 2D analogue systems for clinical practice and trials

Amanda Roby; Lindsey Harmon; Kelly Sander; Linh Bui; Danai Kitkungvan; Monica Patel; Jagat Narula; Nils P Johnson; K Lance Gould

doi:10.1093/ehjimp/qyae115

Reproducibility of quantitative myocardial perfusion and coronary flow capacity by positron emission tomography: 3D digital silicon photomultiplier solid state vs. legacy 2D analogue systems for clinical practice and trials

Eur Heart J Imaging Methods Pract. 2024 Dec 9;2(3):qyae115. doi: 10.1093/ehjimp/qyae115. eCollection 2024 Jul.

Authors

Amanda Roby¹, Lindsey Harmon¹, Kelly Sander¹, Linh Bui¹, Danai Kitkungvan¹, Monica Patel¹, Jagat Narula¹, Nils P Johnson¹, K Lance Gould¹

Affiliation

¹ Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256 Houston, TX 77030, USA.

Abstract

Aims: Quantitative rest-stress myocardial perfusion in millilitres per minute per gram among multiple 2D and 3D positron emission tomography-computed tomography (PET-CT) scanners is essential for personalized cardiac management and clinical trials. Accordingly, this study reports the accuracy and precision of quantitative rest-stress millilitres per minute per gram and coronary flow capacity among 2D and two different digital 3D silicon photomultiplier (SiPM) PET-CT scanners for quantifying the severity of coronary pathophysiology for clinical trials or guiding interventions vs. medical treatment.

Methods and results: One hundred seventy-one participants underwent 748 paired serial rest or stress PET perfusion imaging in the same person on 'same day' or 'different days' using rubidium-82 (Rb-82) pharmacologic stress on 2D and two different digital 3D SiPM PET-CT scanners for global myocardial perfusion in millilitres per minute per gram. For methodological variability of 66 'same-day' serial paired PETs in the same person by 2D and two different 3D SiPM PET-CT scanners, rest-stress global myocardial millilitres per minute per gram had no significant bias (P = 0.464, mean difference 0.014 ± 0.21 mL/min/g) with coefficient of variation (COV) of ±14%. For methodological plus biological variability of 154 'different-day' serial paired PETs, rest-stress global perfusion had no significant bias (P = 0.136), mean difference (0.028 ± 0.33), and COV of ±20%. Coronary flow reserve had a small bias of 0.095 ± 0.57 (P = 0.041) and COV of ±20%. Coronary flow capacity was not different by Kolmogorov-Smirnov test (P = 0.99).

Conclusion: For quantifying myocardial perfusion in the same person on 'same day' or 'different days' using Rb-82, 3D SiPM PET-CT is comparably reproducible to analogue 2D PET-CT with the HeartSee perfusion model as the basis for quantifying physiologic severity of coronary heart disease to guide clinical decision-making or randomized clinical trials confirming these outcomes.

Keywords: coronary flow capacity; coronary flow reserve; coronary physiology; myocardial blood flow; positron emission tomography; quantitative myocardial perfusion.