Vessel-specific quantification of absolute myocardial blood flow, myocardial flow reserve and relative flow reserve by means of fused dynamic (NH3)-N-13 PET and CCTA: Ranges in a low-risk population and abnormality criteria

• Type of Material: Article
• Authors: Marina Piccinelli, Emory University; Sang-Geon Cho, Chonnam National University; Ernest V Garcia, Emory University; Erick Alexanderson, Instituto Nacional de Cardiologia; Joo Myung Lee, Samsung Medical Center; Charles Cooke, Emory University; Nikhil Goyal, Emory University; Mauricio Santos Sanchez, Instituto Nacional de Cardiologia; Russell Folks, Emory University; Zhengjia Chen, Emory University; John Votaw, Emory University; Bon-Kwoon Koo, Seoul National University Hospital; Hee-Seung Bom, Chonnam National University
• Language: English
• Date: 2020-10-01
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Society of Nuclear Cardiology. Published by ELSEVIER INC. All rights reserved. Published by Mosby, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1007/s12350-018-01472-3
• Title of Journal or Parent Work: JOURNAL OF NUCLEAR CARDIOLOGY
• Volume: 27
• Issue: 5
• Start Page: 1756
• End Page: 1769
• Grant/Funding Information: Drs. Cho and Bom wish to acknowledge the Basic Science Research Program that supported this work through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2016R1D1A3B01006631).; Research reported in this publication was supported in part by NIH Grant R01 HL143350–01 (PI: EV Garcia); NIH R44 HL123069 (The National Heart, Lung, And Blood Institute of the NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
• Keywords: PET; Science & Technology; Radiology, Nuclear Medicine & Medical Imaging; Life Sciences & Biomedicine; PERFUSION; myocardial blood flow; multimodality; image-guided application; CORONARY-ARTERY-DISEASE; CAD; Cardiovascular System & Cardiology; CT; Cardiac & Cardiovascular Systems

Abstract

Objectives: The goal of the present work is to present a novel methodology for the extraction of MBF, MFR and RFR along coronary arteries by means of multimodality image fusion of dynamic PET and CCTA images. Background: FFR is the reference standard to identify flow-limiting lesions, but its invasiveness limits broad application. New noninvasive methodologies are warranted to stratify patients and guide treatment. Methods: A group of 16 low-risk CAD subjects who underwent both 13NH3 PET and CCTA were analyzed. Image fusion techniques were employed to align the studies and CCTA-derived anatomy used to identify coronaries trajectories. MBF was calculated by means of a 1-tissue compartmental model for the standard vascular territories and along patient-specific vessel paths from the base to the apex of the heart. Results: Low-risk ranges for MBF. MFR and RFR for LAD, LCX and rPDA were computed for the entire cohort and separated by gender. Computed low-risk ranges were used to assess a prospective patient with suspected CAD. Conclusions: Our vessel-specific functional indexes and 3D displays offer promise to more closely replicate what is commonly performed during a catheterization session and have the potential of providing effective noninvasive tools for the identification of flow-limiting lesions and image-guided therapy.