Fujito Hidesato, Lemley Mark, Builoff Valerie, Zhang Wenhao, Kuronuma Keiichiro, Ramirez Giselle, Killekar Aditya, Liang Joanna X, Kavanagh Paul, Hyun Mark C, Hayes Sean W, Thomson Louise E J, Friedman John D, Van Kriekinge Serge D, Di Carli Marcelo F, Dey Damini, Berman Daniel S, Slomka Piotr J
Department of Medicine, Division of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan.
Department of Medicine, Division of Artificial Intelligence in Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
J Nucl Cardiol. 2025 Aug;50:102270. doi: 10.1016/j.nuclcard.2025.102270. Epub 2025 Jun 7.
We investigated whether the shape of arterial blood input curves affects the diagnostic performance of myocardial blood flow (MBF) on rubidium-82 (Rb) positron emission tomography (PET) myocardial perfusion imaging (MPI) for obstructive coronary artery disease (CAD).
We retrospectively enrolled 386 patients without prior CAD who underwent Rb PET-MPI and invasive coronary angiography within 6 months, from 2010 to 2018. Abnormal shapes of stress left atrial blood pool (BP) time activity curve were characterized into five categories based on visual/quantitative assessment: (1) low stress/rest peak ratio (SRPR), (2) slow activity rise, (3) slow activity decline, (4) broad peak and (5) multiple peaks. The SRPR was defined as the ratio of peak count value on the stress BP activity by rest BP activity. A low SRPR was defined as one below the median value (0.82). We compared the diagnostic performance of stress MBF and myocardial flow reserve for detecting obstructive CAD (≥70% stenosis) using area under the curve (AUC) analysis.
Among the five abnormal categories, the AUC of stress MBF in the low SRPR group (n = 193) was lower than in the normal SRPR group (n = 193) in per-patient (.67 [.59-.74] vs. .78 [.70-.84], P = .0499, respectively) and per-vessel analyses (.68 [.63-0.73] vs. .75 [.71-.79], P = .0352, respectively). The AUC in slow activity rise group (n = 167) for stress MBF was lower than in others in per-vessel analysis (n = 219) (.68 [.62-.72] vs. .75 [.70-.79], P = .0270). Other abnormal profiles showed no significant differences (all P > .05).
Low SRPR and slow activity rise were associated with reduced diagnostic performance of stress MBF.
我们研究了动脉血输入曲线的形状是否会影响82铷（Rb）正电子发射断层扫描（PET）心肌灌注成像（MPI）对阻塞性冠状动脉疾病（CAD）心肌血流（MBF）的诊断性能。
我们回顾性纳入了2010年至2018年期间386例无CAD病史的患者，这些患者在6个月内接受了Rb PET-MPI和有创冠状动脉造影。根据视觉/定量评估，将应激左心房血池（BP）时间-活性曲线的异常形状分为五类：（1）低应激/静息峰值比（SRPR），（2）活性上升缓慢，（3）活性下降缓慢，（4）宽峰，（5）多峰。SRPR定义为应激BP活性峰值计数值与静息BP活性峰值计数值之比。低SRPR定义为低于中位数（0.82）的值。我们使用曲线下面积（AUC）分析比较了应激MBF和心肌血流储备检测阻塞性CAD（≥70%狭窄）的诊断性能。
在这五个异常类别中，低SRPR组（n = 193）应激MBF的AUC在每位患者分析中低于正常SRPR组（n = 193）（分别为0.67[0.59 - 0.74]对0.78[0.70 - 0.84]，P = 0.0499）和每支血管分析中（分别为0.68[0.63 - 0.73]对0.75[0.71 - 0.79]，P = 0.0352）。活性上升缓慢组（n = 167）应激MBF的AUC在每支血管分析中低于其他组（n = 219）（0.68[0.62 - 0.72]对0.75[0.70 - 0.79]，P = 0.0270）。其他异常情况无显著差异（所有P > 0.05）。
低SRPR和活性上升缓慢与应激MBF的诊断性能降低有关。
