Quantitative measurement of regional myocardial blood flow in patients with coronary artery disease by intravenous injection of13N-ammonia in positron emission tomography

Abstract

Measurement of myocardial blood flow with 13N-ammonia, a technique previously employed successfully in animal experiments, was introduced into clinical use to study patients with coronary artery disease. This advance has become possible by the development of a high resolution gated scan positron emission tomographic (PET) scanner equipped with a real time decay correction mechanism, HEADTOME-IV. The information obtainable includes myocardial size and wall motion as well as the absolute quantity of blood flow in various myocardial regions. The technique is simple but requires continuous arterial blood withdrawal for calculation of the arterial input function time integral. The alternative to this technique, i.e. the computation of intra left ventricular blood pool activity by PET is also discussed.

Clinical Value of Absolute Quantification of Myocardial Perfusion With 15 O-Water in Coronary Artery Disease

“…PET is a quantitative technique and allows fast and effective imaging protocols with relatively low radiation burden in both rest and stress. [2][3][4][5][6] Absolute quantification of MBF with PET is performed using the tracer kinetic method, which is based on measuring the in vivo kinetics of a tracer concentration during dynamic acquisition. Normal MBF at rest is from 0.6 to 1 mL/g per minute and increases by 3-to 5-fold in stress as the coronary arteries dilate.…”

Assessment of coronary vasodilator reserve by N-13 ammonia PET using the microsphere method and Patlak plot analysis

“…AB(t)/Ca(t) is assumed to equal one for the time intervals used in analyzing the Patlak plot. Therefore, the intercept of Patlak Plot, MBFZ V/ (MBF + K1)2 + Spb; AB(t)/Ca(t), can be simplified by using Equation 6 and Equation 7 to:…”

Dynamic CZT-SPECT in coronary artery disease: Where are we now?

“…This eventuality can be surmounted by the quantification of myocardial blood flow (MBF) or myocardial perfusion reserve (MPR) using a tracer kinetic method for positron emission tomography (PET). [4][5][6][7] PET MPI is a well-validated noninvasive method for the quantification of myocardial perfusion imaging studies, demonstrating an incremental diagnostic and prognostic power of MPR over relative perfusion imaging findings in patients with suspected or known CAD. 8,9 Hence, PET and fractional flow reserve (FFR) are respectively considered gold standards for noninvasive MBF and MPR quantitative measurement [10][11][12] and invasive assessment of coronary artery stenosis severity.…”