Moody Jonathan B, Lee Benjamin C, Corbett James R, Ficaro Edward P, Murthy Venkatesh L
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.
J Nucl Cardiol. 2015 Oct;22(5):935-51. doi: 10.1007/s12350-015-0100-0. Epub 2015 Apr 14.
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.
PET/CT技术的一些令人兴奋的进展以及方法学的改进最近汇聚在一起，提高了心肌血流和血流储备常规临床定量的可行性。最近令人鼓舞的临床结果表明心肌血流在患者护理中具有重要作用。绝对血流定量可以成为一种强大的临床工具，但其效用将取决于在面对众多潜在方法学误差来源时保持精度和准确性。在此，我们回顾近期数据并强调PET仪器、图像重建和定量方法的影响，同时我们着重介绍目前临床应用最广泛的（82）Rb心脏PET。显然，还需要更多数据，特别是与更新的PET技术相关的数据，以及PET方案和方法的临床标准化数据。我们为此处考虑的方法学因素提供建议。目前，心肌血流储备似乎对各种方法学误差具有显著的稳健性；然而，随着对这些误差来源的更多关注和更详细的理解，仅进行负荷血流测量的临床益处最终可能会得到更充分的实现。
