title: Quantitative myocardial perfusion by O-15-water PET: individualized vs. standardized vascular territories.
abstract: OBJECTIVE
  Reporting of quantitative myocardial blood flow (MBF) is typically performed in standard coronary territories. However, coronary anatomy and myocardial vascular territories vary among individuals, and a coronary artery may erroneously be deemed stenosed or not if territorial demarcation is incorrect. So far, the diagnostic consequences of calculating individually vs. standardly assessed MBF values have not been reported. We examined whether individual reassignment of vascular territories would improve the diagnostic accuracy of MBF with regard to the detection of significant coronary artery disease (CAD).
  
  
  RESULTS
  Forty-four patients with suspected CAD were included prospectively and underwent coronary CT-angiography and quantitative MBF assessment with O-15-water PET followed by invasive, quantitative coronary angiography, which served as reference. MBF was calculated in the vascular territories during adenosine stress according to a standardized 17-segment American Heart Association model and an individualized model, using CT-angiography to adjust the coronary territories to their feeding vessels. Individually defined territories deviated from standard territories in 52% of patients. However, MBF in the three coronary territories defined by standard and individualized models did not differ significantly, except in one patient, in whom the MBF of an individualized coronary territory deviated sufficiently as to change the test from a false positive to a true negative result in this particular territory.
  
  
  CONCLUSIONS
  Disparity between standardized and individualized vascular territories was present in half of the patients, but had little clinical impact. Still, caution should be taken not always to rely on standard territories, as this may at times cause misinterpretation.
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark anders.thomassen@rsyd.dk.
authors.forename: Anders
authors.initials: A
authors.lastname: Thomassen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Petersen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
authors.forename: Allan
authors.initials: A
authors.lastname: Johansen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
authors.forename: Poul-Erik
authors.initials: PE
authors.lastname: Braad
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Axel Cosmus Pyndt
authors.initials: AC
authors.lastname: Diederichsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
authors.forename: Jane Angel
authors.initials: JA
authors.lastname: Simonsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
authors.forename: Poul Flemming
authors.initials: PF
authors.lastname: Høilund-Carlsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016000:Cluster Analysis; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods; D057285:Precision Medicine; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: PET/CT imaging; myocardial blood flow; myocardial vascular territories; quantification