INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA.
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Eur J Nucl Med Mol Imaging. 2023 Dec;51(1):147-158. doi: 10.1007/s00259-023-06414-x. Epub 2023 Sep 18.
To establish requirements for normal databases for quantitative rubidium-82 (Rb) PET MPI analysis with contemporary 3D PET/CT technology and reconstruction methods for maximizing diagnostic accuracy of total perfusion deficit (TPD), a combined metric of defect extent and severity, versus invasive coronary angiography.
In total, 1571 patients with Rb PET/CT MPI on a 3D scanner and stress static images reconstructed with and without time-of-flight (TOF) modeling were identified. An additional eighty low pre-test probability of disease (PTP) patients reported as normal were used to form separate sex-stratified and sex-independent iterative and TOF normal databases. 3D normal databases were applied to matched patient reconstructions to quantify TPD. Per-patient and per-vessel performance of 3D versus 2D PET normal databases was assessed with receiver operator characteristic curve analysis. Diagnostic accuracy was evaluated at optimal thresholds established from PTP patients. Results were compared against logistic regression modeling of TPD adjusted for clinical variables, and standard clinical interpretation.
TPD diagnostic accuracy was significantly higher using 3D PET normal databases (per-patient: 80.1% for 3D databases, versus 74.9% and 77.7% for 2D database applied to iterative and TOF images respectively, p < 0.05). Differences in male and female normal distributions for 3D attenuation-corrected reconstructions were not clinically meaningful; therefore, sex-independent databases were used. Logistic regression modeling including TPD demonstrated improved performance over clinical reads.
Normal databases tailored to 3D PET images provide significantly improved diagnostic accuracy for PET MPI evaluation with automated quantitative TPD. Clinical application of these techniques should be considered to support accurate image interpretation.
为使用当代 3D PET/CT 技术和重建方法的定量铷-82（Rb）PET MPI 分析建立正常数据库的要求，以最大程度地提高总灌注缺损（TPD）的诊断准确性，TPD 是一种综合缺陷程度和严重程度的指标，与有创性冠状动脉造影相比。
共确定了 1571 例接受 Rb PET/CT MPI 检查的患者，这些患者使用 3D 扫描仪进行检查，使用和不使用飞行时间（TOF）建模进行应激静态图像重建。另外 80 例低疾病预测试概率（PTP）的患者报告为正常，用于分别形成男女分层和独立的迭代和 TOF 正常数据库。3D 正常数据库应用于匹配的患者重建以量化 TPD。通过接受者操作特征曲线分析评估 3D 与 2D PET 正常数据库的逐患者和逐血管性能。使用从 PTP 患者中建立的最佳阈值评估诊断准确性。结果与 TPD 的逻辑回归模型进行了比较，该模型调整了临床变量和标准临床解释。
使用 3D PET 正常数据库，TPD 的诊断准确性显著提高（逐患者：3D 数据库为 80.1%，而迭代图像应用的 2D 数据库为 74.9%，TOF 图像应用的 2D 数据库为 77.7%，p<0.05）。3D 衰减校正重建的男性和女性正常分布之间的差异无临床意义；因此，使用了独立于性别的数据库。包括 TPD 的逻辑回归模型显示出比临床阅读更好的性能。
为 3D PET 图像量身定制的正常数据库可显著提高 PET MPI 评估的自动定量 TPD 的诊断准确性。应考虑这些技术的临床应用，以支持准确的图像解释。
