Arida-Moody, L., Moody, J.B., Renaud, J.M. et al. Effects of two patient-specific dosing protocols on measurement of myocardial blood flow with 3D 82Rb cardiac PET. Eur J Nucl Med Mol Imaging 48, 3835–3846 (2021).

Description:
This study evaluated the efficacy of patient-specific dosing protocols, specifically weight- and BMI-adjusted dosing, for quantitative myocardial blood flow (MBF) accuracy in PET myocardial perfusion imaging.

A total of 435 patients underwent rest and stress PET-CT assessments with 82Rb activities, and the effects of the dosing protocols on dose reduction, PET scanner saturation, relative perfusion, and image quality were analyzed. BMI-adjusted dosing resulted in lower administered activities, reduced PET scanner saturation incidence and severity, and maintained image quality and relative perfusion assessment accuracy.

Clinical Relevance:
Implementing BMI-adjusted dosing in PET myocardial perfusion imaging can effectively reduce administered radiotracer doses while preserving image quality and diagnostic accuracy. This approach addresses the guideline-directed need for patient-specific dosing, minimizing radiation exposure and improving scanner performance without compromising the accuracy of MBF and myocardial flow reserve (MFR) quantification. These findings support the routine use of BMI-adjusted dosing in clinical settings to enhance patient safety and the reliability of diagnostic assessments in coronary artery disease management.

Representative static 82Rb PET images comparing image noise in four patients at rest who received weight-adjusted doses (A) and (C) and BMI-adjusted doses (B) and (D). Patients (A) and (B) had similar BMI (~48 kg/m2), and patients (C) and (D) received the same dose (1147 MBq). (A) Male (70 years; 146.5 kg; BMI 47.9 kg/m2) who received 1665 MBq, yielding an estimated image noise of 8%. (B) Male (57 years; 175.5 kg; BMI 48.5kg/m2) who received 1591 MBq, yielding an image noise of 12%. (C) Female (73 years; 95.7 kg; BMI 27.9 kg/m2) with image noise 8.1%. (D) Male (75 years; 105.7 kg; BMI 34.5 kg/m2) with image noise 11.8%. In both cases (B) and (D), the quantitative increases in image noise (COV) that accompanied the BMI protocol were visually judged to be clinically negligible. SA, short axis; HLA, horizontal long axis; VLA, vertical long axis

Partners in Research:
The University of Michigan, INVIA Medical Imaging Solutions, and Siemens Health collaborated on this research.

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