Consistent tracer administration profile improves test-retest repeatability of myocardial blood flow quantification with 82Rb dynamic PET imaging

Objectives. Quantification of myocardial blood flow (MBF) and stress/rest flow reserve is used increasingly to diagnose multi-vessel coronary artery disease and micro-vascular disease with PET imaging. However, variability in the measurements may limit physician confidence to direct revascularization therapies based on specific threshold values. This study evaluated the effects of rubidium-82 (Rb-82) tracer injection profile using a constant-activity-rate (CA) vs a constant-flow-rate (CF) infusion to improve test-retest repeatability of MBF measurements. Method. 22 participants underwent single-session Rb-82 dynamic PET imaging during rest and dipyridamole stress using one of 2 test-retest infusion protocols: CA-CA (n = 12) or CA-CF (n 5 10). MBF was quantified using a single-tissue-compartment model (1TCM) and a simplified retention model (SRM). Non-parametric test-retest repeatability coefficients(RPCnp) were compared between groups. Myocardium-to-blood contrast and signal-to-noise ratios of the late uptake images (2 to 6 minutes) were also compared to evaluate standard myocardial perfusion image (MPI) quality. Results. MBF values in the CA-CA group were more repeatable (smaller RPCnp) than the CA-CF group using the 1TCM at rest alone, rest and stress combined, and stress/rest reserve (21% vs 36%, 16% vs 19%, and 20% vs 27%, P < 0.05, respectively), and using the SRM at Rest and Stress alone, Rest and Stress combined, and stress/rest reserve (21% vs 38%, 15% vs 25%, 22% vs 38%, and 23% vs 49%, P < 0.05, respectively). In terms of image quality, myocardium-toblood contrast and signal-to-noise ratios were not significantly different between groups. Conclusions. Constant-activity-rate 'square-wave' infusion of Rb-82 produces more repeatable tracer injection profiles and decreases the test-retest variability of MBF measurements, when compared to a constant-flow-rate 'bolus' administration of Rb-82, especially with SRM, and without compromising standard MPI quality.