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Optimization of myocardial blood flow quantification in Rubidium-82 PET myocardial perfusion imaging

Koenders, S.S. (2018) Optimization of myocardial blood flow quantification in Rubidium-82 PET myocardial perfusion imaging.

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Abstract:Introduction: Cardiovascular disease is the second leading cause of death in the Netherlands. Of these cardiovascular deaths, 22% is due to coronary artery disease (CAD). Early detection and accurate diagnosis of CAD are essential. Myocardial blood flow (MBF) quantification using Rubidium82 (Rb-82) in myocardial perfusion imaging (MPI) with positron emission tomography (PET) is increasing rapidly and is of added value in the diagnosis of CAD. MBF quantification provides valuable additional prognostic information. Further optimization of MBF quantification is required for more accurate MBF quantification and might offer the possibility for a “one-stop shop”. The aims were to 1) determine the impact of non-returning motion of the myocardium during pharmacological induced stress, called myocardial creep, on MBF quantification and 2) to derive and validate a temporal sampling protocol with a minimum number of time frames that still results in precise MBF quantification. Myocardial creep Method: Presence of myocardial creep was visually detected and corrected. Uncorrected and corrected MBFs for the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) and the whole myocardium were compared. In addition, instructions on how to detect and correct for myocardial creep and an overview of software packages able to perform this correction were provided in a technical note. Results: Myocardial creep was detected in 52% of the patients and significantly influenced the MBF values, especially in the RCA territory, as shown in Figure 1. In patients with myocardial creep, 83% had a change in MBF of >10% which is considered to possibly influence diagnostic interpretation. Only two of the four commonly used software packages to quantify MBF have the functionality to detect and correct for myocardial creep. Conclusion: Detection and correction of myocardial creep seems necessary to obtain accurate MBFs using PET Rb-82 as it may influence diagnosis. It is therefore important that all vendors provide this functionality in their software. Minimization of temporal sampling protocol Method: A simulation tool was used to assess the influence of minimizing temporal sampling using varying protocols with 26 to 14 frames. Protocols were considered for validation if the SD of the relative differences, with 26 frames as reference, was ≤5%. Next, two accepted protocols were validated. Rest and stress MBFs were calculated and compared between the new and reference protocol in clinical practice. New protocols were considered for clinical adoption if the SD of the relative differences was ≤10%. Results: Six of the nine tested temporal sampling protocols were considered to provide precise results. The protocols with 20 and 14 frames were validated in clinical practice. Both protocols were considered for clinical adoption as the SDs of the relative differences were ≤10% for rest and stress global MBF (whole myocardium). Conclusion: The choice of temporal sampling protocol influences MBF outcomes. The minimum number of time frames that can be considered for clinical adoption is 14 frames. This reduces reconstruction time and might provide the possibility for a “one-stop shop”.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/75947
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