title: Characterizing the normal range of myocardial blood flow with ⁸²rubidium and ¹³N-ammonia PET imaging.
abstract: BACKGROUND
  Diagnosis of coronary disease and microvascular dysfunction may be improved by comparing myocardial perfusion scans with a database defining the lower limit of normal myocardial blood flow and flow reserve (MFR). To maximize disease detection sensitivity, a small normal range is desirable. Both (13)N-ammonia and (82)Rb tracers are used to quantify blood flow and MFR using positron emission tomography (PET). The goal of this study was to investigate the trade-off between noise and accuracy in both (82)Rb and (13)N-ammonia normal databases formed using a net retention model.
  
  
  METHODS
  Fourteen subjects with <5% risk of CAD underwent rest and stress (82)Rb and (13)N-ammonia dynamic PET imaging in a randomized order within 2 weeks. Myocardial blood flow was quantified using a one-compartment model for (82)Rb, and a two-compartment model for (13)N-ammonia. A simplified model was used to estimate tracer retention, with tracer-specific net extraction functions derived to obtain flow estimates.
  
  
  RESULTS
  Normal variability of retention reserve was equivalent for both tracers (±15% globally, ±16% regionally) and was lower in comparison to compartment model results (P < .05). The two-compartment model for (13)N-ammonia had the smallest normal range of global blood flow resulting in a lower limit of normal MFR = 2.2 (mean - 2 SD).
  
  
  CONCLUSIONS
  These results suggest that the retention model may have higher sensitivity for detection and localization of abnormal flow and MFR using (82)Rb and (13)N-ammonia, whereas the (13)N-ammonia two-compartment model has higher precision for absolute flow quantification.
authors: Department of Physics, University of Ottawa-Carleton University Institute of Physics, Ottawa, ON, Canada. jrenaud@ottawaheart.ca
authors: Jennifer M
authors: JM
authors: Renaud
authors: Jean N
authors: JN
authors: DaSilva
authors: Rob S B
authors: RS
authors: Beanlands
authors: Robert A
authors: RA
authors: DeKemp
mesh_terms: D000328:Adult; D000641:Ammonia / Q000737:chemistry; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003326:Coronary Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008833:Microcirculation; D009590:Nitrogen Radioisotopes / Q000737:chemistry*; D049268:Positron-Emission Tomography / Q000379:methods* / Q000592:standards; D012016:Reference Values; D012039:Regional Blood Flow; D012414:Rubidium Radioisotopes / Q000737:chemistry*
chemical_list: D009590:Nitrogen Radioisotopes; D012414:Rubidium Radioisotopes; D000641:Ammonia
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