Clinical cardiac PET using generator-produced Rb-82: A review

Gould, K. Lance

doi:10.1007/bf02575408

Cited by 28 publications

(15 citation statements)

References 45 publications

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“…At rest, an activity of 1.30–1.67 GBq (35–45 mCi) of 82 Rb from a strontium-rubidium generator, which measured the delivered dose using a beta probe, was infused over 20–30 seconds (Bracco Diagnostics Inc., Princeton, NJ, USA). 9 Initial quality control checks were performed immediately during the first-pass data acquisition phase by having the supervising cardiologist monitor the beta-probe readout of count rate changes during injection; only data for which count rates were consistent with an effectively delivered bolus of injected activity were analyzed. At peak pharmacologic stress, when hemodynamic steady state was achieved, an isotope dose with activity similar to that used for rest imaging was infused.…”

Section: Methodsmentioning

confidence: 99%

The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated 82Rb PET myocardial perfusion imaging

Tosh

Votaw

Reichek

et al. 2013

Journal of Nuclear Cardiology

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Background Gated rubidium-82 (82Rb) positron emission tomography (PET) imaging studies are acquired both at rest and during pharmacologic stress. Stress-induced ischemic left ventricular dysfunction (LVD) can produce a significant decrease in left ventricular ejection fraction (LVEF) from rest to stress. We determined the prevalence on PET of stress LVD with reduced ejection fraction (EF) and its association with absolute global and regional coronary flow reserve (CFR), and with relative perfusion defect summed difference score (SDS). Methods and Results We studied 205 patients with known or suspected coronary disease (120 M, 75 F, age 69 ± 13 years) who had clinically indicated rest/regadenoson stress 82Rb PET/CT studies. Data were acquired in dynamic gated list mode. Global and 17-segment regional CFR values were computed from first-pass flow data using a 2-compartment model and factor analysis applied to auto-generated time-activity curves. Rest and stress LVEF and SDS were quantified from gated equilibrium myocardial perfusion tomograms using Emory Cardiac Toolbox software. LVD was defined as a change in LVEF of ≤−5% from rest to stress. A subgroup of 109 patients also had coronary angiography. Stress LVD developed in 32 patients (16%), with mean EF change of −10 ± 5%, vs +6 ± 7% for patients without LVD (P < .0001). EF was similar at rest in patients with and without stress LVD (57 ± 18% vs 56 ± 16%, P = .63), but lower during stress for patients with LVD (47 ± 20% vs 61 ± 16%, P = .0001). CFR was significantly lower in patients with LVD (1.61 ± 0.67 vs 2.21 ± 1.03, Wilcoxon P = .002), and correlated significantly with change in EF (r = 0.35, P < .0001), but not with SDS (r = −0.13, P = .07). The single variable most strongly associated with high risk of CAD (i.e., left main stenosis ≥50%, LAD % stenosis ≥70%, and/or 3-vessel disease) was stress EF (χ2 = 17.3, P < .0001). There was a higher prevalence of patients with territorial CFR values ≤1.0, consistent with coronary steal, in the LVD group than in the non-LVD group (39% vs 12%, P = .001). Conclusions LVD developed in 16% of patients undergoing 82Rb PET myocardial perfusion imaging, and was associated with multivessel coronary artery disease. There was a significant relationship between LVD and coronary blood flow during stress, with LVD corresponding to a low CFR. Territorial CFR ≤1.0 was more common in patients with LVD than those without, suggesting that coronary steal is an important pathophysiologic mechanism contributing to pharmacologic stress-induced LVD.

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Section: Methodsmentioning

confidence: 99%

The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated 82Rb PET myocardial perfusion imaging

Tosh

Votaw

Reichek

et al. 2013

Journal of Nuclear Cardiology

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“…Stress was induced pharmacologically using regadenoson, following standardized protocols that included patient preparation, a period of fasting, abstention from caffeine, and withholding of cardiac medications (16,17). Throughout imaging, physiologic parameters were monitored and recorded, including blood pressure, heart rate, and cardiac rhythm.…”

Section: Image Acquisitionmentioning

confidence: 99%

“…Rest images were acquired in gated list mode over 7 min, with data acquisition beginning just before the start of a 30-s continuous infusion of 0.94-1.22 GBq (35-45 mCi) of 82 Rb eluted from a strontium-rubidium generator (Bracco Diagnostics Inc.). A supervising cardiologist used a b-probe to monitor activity delivered to the patient during 82 Rb infusion (17), to ensure that delivery of the bolus was sufficiently rapid to provide valid firstpass information. Data were discarded and not subsequently analyzed for any cases in which bolus delivery was inadequate.…”

Section: Image Acquisitionmentioning

confidence: 99%

Effect of Outflow Tract Contributions to ⁸²Rb-PET Global Myocardial Blood Flow Computations

Tosh

Reichek

Palestro

et al. 2016

J. Nucl. Med. Technol.

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Algorithms are able to compute myocardial blood flow (MBF) from dynamic PET data for each of the 17 left ventricular segments, with global MBF obtained by averaging segmental values. This study was undertaken to compare MBFs with and without the basal-septal segments. Methods: Data were examined retrospectively for 196 patients who underwent rest and regadenoson-stress 82 Rb PET/CT scanning for evaluation of known or suspected coronary artery disease. MBF data were acquired in gated list mode and rebinned to isolate the firstpass dynamic portion. Coronary vascular resistance (CVR) was computed as mean arterial pressure divided by MBF. MBF inhomogeneity was computed as the ratio of SD to mean MBF. Relative perfusion scores were obtained using 82 Rbspecific normal limits applied to polar maps of myocardial perfusion generated from myocardial equilibrium portions of PET data. MBF and CVRs from 17 and 14 segments were compared. Results: Mean MBFs were lower for 17-than 14-segment means for rest (0.78 ± 0.50 vs. 0.85 ± 0.54 mL/g/min, paired t test P , 0.0001) and stress (1.50 ± 0.88 vs. 1.67 ± 0.96 mL/g/min, P , 0.0001). Bland-Altman plots of MBF differences versus means exhibited nonzero intercept (−0.04 ± 0.01, P 5 0.0004) and significant correlation (r 5 −0.64, P , 0.0001), with slopes significantly different from 0.0 (−7.2% ± 0.6% and −8.3% ± 0.7% for rest and stress MBF; P , 0.0001). Seventeen-segment CVRs were higher than 14-segment CVRs for rest (159 ± 86 vs. 147 ± 81 mm Hg/mL/g/min, paired t test P , 0.0001) and stress CVR (85 ± 52 vs. 76 ± 48 mm Hg/mL/g/min, P , 0.0001). MBF inhomogeneity correlated significantly (P , 0.0001) with summed perfusion scores, but values correlated significantly more strongly for 14-than 17-segment values for rest (r 5 0.67 vs. r 5 0.52, P 5 0.02) and stress (r 5 0.69 vs. r 5 0.47, P 5 0.001). When basal segments were included in MBF determinations, perfusion inhomogeneity was greater both for rest (39% ± 10% vs. 31% ± 10%, P , 0.0001) and for stress (42% ± 12% vs. 32% ± 11%, P , 0.0001). Conclusion: Averaging 17 versus 14 segments leads to systematically 7%-8% lower MBF calculations, higher CVRs, and greater computed inhomogeneity. Consideration should be given to excluding basal-septal segments from standard global MBF determination.

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“…In Rb-82 PET imaging, the short half-life of the tracer (76 s) makes possible rapid MP rest/stress paired studies within a very short time, allowing rest and stress imaging under virtually identical conditions and decreasing the total time required to scan each patient. As such, cardiac PET with Rb-82 allows a readily feasible and convenient assessment of myocardial perfusion [13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

4D respiratory motion-corrected Rb-82 myocardial perfusion PET image reconstruction

Rahmim

Tang

et al. 2010

IEEE Nuclear Science Symposuim &Amp; Medical Imaging Conference

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Routine clinical myocardial perfusion (MP) PET imaging involves the use of cardiac gating only. Nonetheless, respiratory motion of the heart can considerably degrade the quality of MP images and the quantitative accuracy of myocardial uptake estimates. We first performed a quantitative evaluation of the degrading contributions of cardiac (C) and respiratory (R) motion, as well as non-motion factors of Rb-82 positron range, photon non-collinearity, crystal scattering and penetration. For a normal human simulated phantom, we showed that the combination of all above factors resulted in ~48% underestimation of myocardial activity, while corrections for all non-motion factors resulted in 21%, 36% and 41% underestimated myocardial activities in the presence of C, R and C&R motion. This means that compensation for respiratory motion must be considered as critical towards achieving overall motion compensation and/or resolution modeling.To achieve respiratory motion compensation, we used translation motion vectors to first match respiratory-only gated images to the end-expiration reference frame. Next, for each cardiac gate, a 4D EM reconstruction algorithm was applied to the R-gated data within that cardiac phase. Three techniques were compared involving reconstructions of (a) a single R-gate only, and all R-gates (b) without and (c) with respiratory motion correction (MC). Using simulated PET data, quantitative comparisons of noise vs. bias trace-off curves indicated notable improvements for the proposed 4D respiratory MC method. Using CHO analysis as applied to the task of perfusion defect detection, ROC analysis of the three methods resulted in AUC values of 0.610±0.039, 0.645±0.038 and 0.821±0.029. The CLABROC statistical test revealed that the proposed MC technique significantly outperformed the other two methods in the task of defect detection.

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Clinical cardiac PET using generator-produced Rb-82: A review

Cited by 28 publications

References 45 publications

The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated 82Rb PET myocardial perfusion imaging

The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated 82Rb PET myocardial perfusion imaging

Effect of Outflow Tract Contributions to ⁸²Rb-PET Global Myocardial Blood Flow Computations

4D respiratory motion-corrected Rb-82 myocardial perfusion PET image reconstruction

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Clinical cardiac PET using generator-produced Rb-82: A review

Cited by 28 publications

References 45 publications

The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated 82Rb PET myocardial perfusion imaging

The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated 82Rb PET myocardial perfusion imaging

Effect of Outflow Tract Contributions to 82Rb-PET Global Myocardial Blood Flow Computations

4D respiratory motion-corrected Rb-82 myocardial perfusion PET image reconstruction

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Effect of Outflow Tract Contributions to ⁸²Rb-PET Global Myocardial Blood Flow Computations