13N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

Siegrist, Patrick T.; Husmann, Lars; Knabenhans, Martina; Gaemperli, Oliver; Valenta, Ines; Hoefflinghaus, Tobias; Scheffel, Hans; Stolzmann, Paul; Alkadhi, Hatem; Kaufmann, Philipp A.

doi:10.1007/s00259-007-0647-3

Cited by 33 publications

(26 citation statements)

References 27 publications

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“…Analysis of the small-animal PET images was performed with PMOD software (PMOD Technologies Ltd.) (6). To determine pharmacokinetics, a region of interest was drawn around the heart.…”

Section: Small-animal Pet Study and Image Analysismentioning

confidence: 99%

“…Because of these advantages, it allows quantitative measures of myocardial tracer uptake and regional myocardial blood flow (5). However, the PET tracers currently used for myocardial perfusion imaging have a short half-life ( 13 N-NH 3 , 9.97 min; 82 Rb, 1.27 min; 15 O-H 2 O, 2.04 min), limiting widespread clinical use of PET because of the need for an on-site cyclotron or generator (6,7). The use of 18 F-labeled myocardial perfusion agents could overcome these limitations and simplify clinical protocols as a result of the longer half-life (109.8 min) and better spatial resolution and quantification (5,8).…”

mentioning

confidence: 99%

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Comparison of ¹⁸F-Labeled Fluoroalkylphosphonium Cations with ¹³N-NH₃ for PET Myocardial Perfusion Imaging

Kim

Reder

et al. 2015

J Nucl Med

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Despite substantial advances in the diagnosis of cardiovascular disease, there is a need for 18 F-labeled myocardial perfusion agents for the diagnosis of ischemic heart disease because current PET tracers for myocardial perfusion imaging have a short half-life that limits their widespread clinical use in PET. Thus, 18 F-labeled fluoroalkylphosphonium derivatives ( 18 F-FATPs), including (5-18 F-fluoropentyl)triphenylphosphonium cation ( 18 F-FPTP), (6-18 F-fluorohexyl)triphenylphosphonium cation ( 18 F-FHTP), and (2-(2-18 F-fluoroethoxy)ethyl)triphenylphosphonium cation ( 18 F-FETP), were synthesized. The myocardial extraction and image quality of the 18 F-FATPs were compared with those of 13 N-NH 3 in rat models. Methods: The first-pass extraction fraction (EF) values of the 18 F-FATPs ( 18 F-FPTP, 18 F-FHTP, 18 F-FETP) and 13 N-NH 3 were measured in isolated rat hearts perfused with the Langendorff method (flow velocities, 0.5, 4.0, 8.0, and 16.0 mL/min). Normal and myocardial infarction rats were imaged with small-animal PET after intravenous injection of 37 MBq of 18 F-FATPs and 13 N-NH 3. To determine pharmacokinetics, a region of interest was drawn around the heart, and time-activity curves of the 18 F-FATPs and 13 N-NH 3 were generated to obtain the counts per pixel per second. Defect size was analyzed on the basis of polar map images of 18 F-FATPs and 13 N-NH 3. Results:The EF values of 18 F-FATPs and 13 N-NH 3 were comparable at low flow velocity (0.5 mL/min), whereas at higher flows EF values of 18 F-FATPs were significantly higher than those of 13 N-NH 3 (4.0, 8.0, and 16.0 mL/min, P , 0.05). Myocardium-to-liver ratios of 18 F-FPTP, 18 F-FHTP, 18 F-FETP, and 13 N-NH 3 were 2.10 ± 0.30, 4.36 ± 0.20, 3.88 ± 1.03, and 0.70 ± 0.09, respectively, 10 min after injection, whereas myocardium-to-lung ratios were 5.00 ± 0.25, 4.33 ± 0.20, 7.98 ± 1.23, and 2.26 ± 0.14, respectively. Although 18 F-FATPs and 13 N-NH 3 sharply delineated myocardial perfusion defects, defect size on the 13 N-NH 3 images was significantly smaller than on the 18 F-FATP images soon after tracer injection (0-10 min, P 5 0.027). Conclusion: 18 F-FATPs exhibit higher EF values and more rapid clearance from the liver and lung than 13 N-NH 3 in normal rats, which led to excellent image quality in a rat model of coronary occlusion. Therefore, 18 FFATPs are promising new PET radiopharmaceuticals for myocardial perfusion imaging.

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“…Analysis of the small-animal PET images was performed with PMOD software (PMOD Technologies Ltd.) (6). To determine pharmacokinetics, a region of interest was drawn around the heart.…”

Section: Small-animal Pet Study and Image Analysismentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of ¹⁸F-Labeled Fluoroalkylphosphonium Cations with ¹³N-NH₃ for PET Myocardial Perfusion Imaging

Kim

Reder

et al. 2015

J Nucl Med

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“…In the present study by Siegrist et al [8], CT was used only for attenuation correction. In future, it would be very interesting to study the clinical impact and cost-effectiveness of true hybrid imaging with CT angiography and perfusion imaging in a real clinical setting.…”

mentioning

confidence: 79%

“…In the current issue of this journal, Siegrist et al [8] investigated the impact of 13 N-ammonia myocardial PET perfusion imaging on clinical decision-making and the costeffectiveness in 100 consecutive patients with high likelihood of CAD or known CAD. The patient management decisions were assessed without and with the knowledge of PET results.…”

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confidence: 99%

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Should we use more PET-CT in clinical cardiology?

Knuuti

2008

Eur J Nucl Med Mol Imaging

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Recently, positron emission tomography (PET) has been increasingly used also in clinical cardiac imaging. The newest development, the hybrid imaging devices with 64-slice computed tomography (CT), have become available aiming specifically to cardiac imaging and has made this technique very attractive alternative to single photon emission computed tomography (SPECT) imaging.There are several advantages of PET as compared to SPECT. The perfusion imaging protocols with PET are faster due to shorter half-lives of the tracers and allow more efficient patient throughput. The radiation dose for the patients is only fraction of the doses provided by 99m Tc and 201 Tl, at least when 15 O-water or 13 NH 3 are used. The image artifacts are less common, the attenuation correction is well established and less susceptible to technical problems. These technical advantages have shown to increase the specificity and accuracy in detection of coronary artery disease (CAD) [1][2][3][4]. The higher spatial resolution and heart-to-background ratios seem to lead improved detection of small perfusion defects and, thus, to higher sensitivity. Currently, PET imaging has been primarily suggested to be used in difficult patient populations such as obese and diabetic subjects.The unique characteristic of PET is that it allows noninvasive quantification of myocardial blood flow (MBF) and metabolism. Measurement of MBF and coronary-flow reserve provides information on both the macro-and the micro-circulation and likely more accurate detection of both early and advanced disease [5][6][7]. Do these technical advantages and improved accuracy justify the use of PET in clinical routine? Myocardial perfusion SPECT has a huge amount of evidence supporting its robustness and accuracy in the detection of CAD, and its prognostic value is proven. The strengths and limitations of the technique are well known. Experienced staff is existing to deliver high quality service worldwide. It is obvious that to overtake the role of SPECT perfusion imaging is not an easy task for any technique.The limitations of PET are also currently obvious. While the availability of scanners is rapidly improving, the tracer production remains a major bottleneck. Without large multi-centre trials documenting the improved accuracy leading to improved patient care or cost savings, the justification of wider use of PET is difficult. Subsequently, without wider utilisation of the technique, new investments to PET tracer production are not sustainable.In the current issue of this journal, Siegrist et al.[8] investigated the impact of 13 N-ammonia myocardial PET perfusion imaging on clinical decision-making and the costeffectiveness in 100 consecutive patients with high likelihood of CAD or known CAD. The patient management decisions were assessed without and with the knowledge of PET results. The authors found that the management changed in 78 patients of 100 using PET perfusion information. In addition, the final clinical management decisions were in agreement with the PET finding...

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Synthesis and Evaluation of 18F-Labeled Fluoroalkyl Triphenylphosphonium Salts as Mitochondrial Voltage Sensors in PET Myocardial Imaging

Kim

Min

2021

Methods in Molecular Biology

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13N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

Abstract: Purpose The purpose of the study is to determine the impact of

Cited by 33 publications

References 27 publications

Comparison of ¹⁸F-Labeled Fluoroalkylphosphonium Cations with ¹³N-NH₃ for PET Myocardial Perfusion Imaging

Comparison of ¹⁸F-Labeled Fluoroalkylphosphonium Cations with ¹³N-NH₃ for PET Myocardial Perfusion Imaging

Should we use more PET-CT in clinical cardiology?

Synthesis and Evaluation of 18F-Labeled Fluoroalkyl Triphenylphosphonium Salts as Mitochondrial Voltage Sensors in PET Myocardial Imaging

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13N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

Abstract: Purpose The purpose of the study is to determine the impact of

Cited by 33 publications

References 27 publications

Comparison of 18F-Labeled Fluoroalkylphosphonium Cations with 13N-NH3 for PET Myocardial Perfusion Imaging

Comparison of 18F-Labeled Fluoroalkylphosphonium Cations with 13N-NH3 for PET Myocardial Perfusion Imaging

Should we use more PET-CT in clinical cardiology?

Synthesis and Evaluation of 18F-Labeled Fluoroalkyl Triphenylphosphonium Salts as Mitochondrial Voltage Sensors in PET Myocardial Imaging

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Comparison of ¹⁸F-Labeled Fluoroalkylphosphonium Cations with ¹³N-NH₃ for PET Myocardial Perfusion Imaging

Comparison of ¹⁸F-Labeled Fluoroalkylphosphonium Cations with ¹³N-NH₃ for PET Myocardial Perfusion Imaging