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• W2011017871 abstract "The current issue of the Journal of Nuclear Cardiology includes an interesting investigation that studied 3 software approaches for quantitating myocardial blood flow (MBF) and MBF reserve (MBFR) in 49 subjects who met multiple criteria for having normal cardiovascular physiology: able to exercise to a high level without chest pain or ischemic end-points, no major risk factors, and normal rubidium-82 myocardial perfusion images. The study found that these important flow measurements in apparently normal subjects varied substantially according to age, gender, coronary territory, and software employed. The results raise legitimate questions about whether positron emission tomography (PET) derived flow quantitation is currently sufficiently mature for inclusion in clinical imaging reports that might influence subsequent patient care. Performance of radionuclide myocardial perfusion imaging (MPI) using PET has been engendering interest and significant volume growth over the past few years. PET has been shown to offer improved image quality, interpretive certainty, and accuracy compared to both traditionally performed and attenuation-corrected single photon emission computed tomography (SPECT) MPI. PET MPI is most commonly performed with rubidium-82, a tracer that decays rapidly due to its 75 seconds half-life. Attractive attributes include throughput efficiency (rest/stress studies can be completed in about 40 minutes), low radiation exposure, peak stress regional and global ventricular function comparisons against rest parameters, and flow measurements validated against a variety of different standards. A novel capability of PET is the ability to move beyond spatially relative image interpretation to patientcentric quantitation. In a spatially relative domain, abnormality is defined in one of 3 manners: one or two myocardial regions have less tracer uptake than a best and therefore presumed normal area; the left ventricle function deteriorates with stress (e.g., transient ischemic dilation, changes between rest and stress ejection fraction); or a non-perfusion marker such as lung uptake of Tl-201 or ischemic ECG changes alert to physiologically significant CAD not detected by perfusion defect analysis alone. PET’s patient-centric quantitation advances understanding about adequacy of MBF by providing an absolute measure of both global and regional blood flow at rest, at stress, and in relative terms as a ratio between stress and rest. As such, the truly unique contribution of PET is measurement of whether the myocardium is getting the blood flow necessary to meet needs, regardless of the basis for any limitation. Identified sites of blood flow compromise include the epicardial coronary arteries (local or diffuse stenoses, endothelial dysfunction/inflammation), the microcirculation, and increased epicardial-endocardial pressure gradients. These measurements have found value in improved risk stratification in varied patient populations, and for improved recognition of multi-vessel CAD. Two important questions arise in consideration of how PET flow measurements might fit into the testing paradigm for CAD. The first is a population-based concept; on a macro-level can MBF calculations help to inform about relative coronary circulation health and improve ability to risk-stratify patients? The second Reprint requests: Timothy M. Bateman, MD, Saint-Lukes Cardiovascular Consultants Mid America Heart Institute, Kansas City, MO; tbateman@saint-lukes.org J Nucl Cardiol 2015;22:85–8. 1071-3581/$34.00 Copyright 2014 American Society of Nuclear Cardiology." @default.
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• W2011017871 date "2014-10-24" @default.
• W2011017871 modified "2023-09-23" @default.
• W2011017871 title "Variability in normal myocardial blood flow measurements: Physiologic, methodologic, or protocol related?" @default.
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• W2011017871 doi "https://doi.org/10.1007/s12350-014-0007-1" @default.
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