J Cardiovasc Imaging.  2020 Apr;28(2):94-105. 10.4250/jcvi.2019.0087.

Diagnostic Value of Lesion-specific Measurement of Myocardial Blood Flow Using Hybrid PET/CT

• Cho SG
• Kim HS
• Cho JY
• Kim JH
• Bom HS

• KMID: 2509452
• DOI: http://doi.org/10.4250/jcvi.2019.0087

Abstract

BACKGROUND
We evaluated whether lesion-specific measurement of myocardial blood flow (MBF) and flow reserve (MFR) by hybrid imaging of myocardial perfusion positron emission tomography (PET) and coronary computed tomography (CT) can provide additional diagnostic value.
METHODS
Forty-three patients with stable angina underwent N-13 ammonia PET and coronary CT before invasive coronary angiography (CAG). The lesion-specific MBF was calculated from the average MBF of the myocardial segments downstream of a coronary stenosis using hybrid PET/CT images. The hyperemic MBF, resting MBF, and MFR were measured for the left anterior descending artery (LAD) using conventional and lesion-specific methods. The diagnostic accuracy was compared between the two methods for significant LAD stenoses (≥ 70% reference diameter on CAG).
RESULTS
There were 19 significant LAD stenoses. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 71%, 68%, 74%, 65%, and 70% for conventional hyperemic MBF (optimal cutoff = 2.15 mL/min/g), 79%, 63%, 74%, 65%, and 70% for conventional MFR (optimal cutoff = 1.82), 83%, 74%, 80%, 78%, and 80% for lesion-specific hyperemic MBF (optimal cutoff = 1.75 mL/min/g), and 79%, 79%, 83%, 75%, and 79% for lesion-specific MFR (optimal cutoff = 1.86), respectively. The lesion-specific measurement was more accurate and had a better linear correlation with anatomical stenosis severity for both hyperemic MBF and MFR.
CONCLUSIONS
Lesion-specific measurement using hybrid PET/CT imaging showed significant improvement in the diagnostic accuracy of PET-measured hyperemic MBF and MFR.

Keyword

Positron emission tomography; Computed tomography; Hybrid imaging; Lesion-specific myocardial blood flow; Coronary artery disease

Figure

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  Figure 1 Conventional and lesion-specific measurements of the MBF and MFR in a patient with a significant mid-LAD stenosis (89% reference diameter). For a lesion-specific MBF measurement, the segments downstream of the mid-LAD stenosis (segments 8, 13, 14, and 17) were isolated and their average MBF values were obtained. LAD: left anterior descending artery, MBF: myocardial blood flow, MFR: myocardial flow reserve.

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  Figure 2 Comparison of MBF and MFR measured by conventional and lesion-specific methods.The hyperemic MBF and MFR significantly decreased after applying lesion-specific measurement, while the resting MBF remained similar. MBF: myocardial blood flow, MFR: myocardial flow reserve.

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  Figure 3 Comparison of the MBF and MFR between LADs with and without significant stenosis for conventional (A) and lesion-specific (B) methods. LAD: left anterior descending artery, MBF: myocardial blood flow, MFR: myocardial flow reserve.

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  Figure 4 Comparison of the diagnostic accuracy according to the measurement method (A) and MBF parameters (B). MBF: myocardial blood flow, MFR: myocardial flow reserve.

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  Figure 5 Correlation between the MBF parameters and anatomical stenosis severity for conventional (A) and lesion-specific (B) methods. MBF: myocardial blood flow, MFR: myocardial flow reserve.

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