title: Precision and accuracy of clinical quantification of myocardial blood flow by dynamic PET: A technical perspective.
abstract: A number of exciting advances in PET/CT technology and improvements in methodology have recently converged to enhance the feasibility of routine clinical quantification of myocardial blood flow and flow reserve. Recent promising clinical results are pointing toward an important role for myocardial blood flow in the care of patients. Absolute blood flow quantification can be a powerful clinical tool, but its utility will depend on maintaining precision and accuracy in the face of numerous potential sources of methodological errors. Here we review recent data and highlight the impact of PET instrumentation, image reconstruction, and quantification methods, and we emphasize (82)Rb cardiac PET which currently has the widest clinical application. It will be apparent that more data are needed, particularly in relation to newer PET technologies, as well as clinical standardization of PET protocols and methods. We provide recommendations for the methodological factors considered here. At present, myocardial flow reserve appears to be remarkably robust to various methodological errors; however, with greater attention to and more detailed understanding of these sources of error, the clinical benefits of stress-only blood flow measurement may eventually be more fully realized.
authors: INVIA Medical Imaging Solutions, Ann Arbor, MI, USA.
authors: Jonathan B
authors: JB
authors: Moody
authors: INVIA Medical Imaging Solutions, Ann Arbor, MI, USA.
authors: Benjamin C
authors: BC
authors: Lee
authors: Division of Nuclear Medicine, Department of Radiology, University of Michigan, 1338 Cardiovascular Center, 1500 E. Medical Center Dr, SPC 5873, Ann Arbor, MI, 48109-5873, USA.|Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors: James R
authors: JR
authors: Corbett
authors: INVIA Medical Imaging Solutions, Ann Arbor, MI, USA.|Division of Nuclear Medicine, Department of Radiology, University of Michigan, 1338 Cardiovascular Center, 1500 E. Medical Center Dr, SPC 5873, Ann Arbor, MI, 48109-5873, USA.
authors: Edward P
authors: EP
authors: Ficaro
authors: Division of Nuclear Medicine, Department of Radiology, University of Michigan, 1338 Cardiovascular Center, 1500 E. Medical Center Dr, SPC 5873, Ann Arbor, MI, 48109-5873, USA. vlmurthy@med.umich.edu.|Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. vlmurthy@med.umich.edu.
authors: Venkatesh L
authors: VL
authors: Murthy
mesh_terms: D000818:Animals; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003326:Coronary Circulation; D005080:Exercise Test; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009038:Motion; D009206:Myocardium / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods*; D015995:Prevalence; D015203:Reproducibility of Results; D012107:Research Design; D012414:Rubidium Radioisotopes / Q000737:chemistry; D012542:Scattering, Radiation; D012984:Software; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left
chemical_list: D012414:Rubidium Radioisotopes
keywords: Cardiac PET/CT; Myocardial blood flow; Myocardial flow reserve; Rubidium-82