Improved myocardial blood flow estimation with residual activity correction and motion correction in 18 F-flurpiridaz PET myocardial perfusion imaging

Purpose We sought to evaluate the diagnostic performance for coronary artery disease (CAD) of myocardial blood flow (MBF) quantification with 18 F-flurpiridaz PET using motion correction (MC) and residual activity correction (RAC). Methods In total, 231 patients undergoing same-day pharmacologic rest and stress 18 F-flurpiridaz PET from Phase III Flurpiridaz trial (NCT01347710) were studied. Frame-by-frame MC was performed and RAC was accomplished by subtracting the rest residual counts from the dynamic stress polar maps. MBF and myocardial flow reserve (MFR) were derived with a two-compartment early kinetic model for the entire left ventricle (global), each coronary territory, and 17-segment. Global and minimal values of three territorial (minimal vessel) and segmental estimation (minimal segment) of stress MBF and MFR were evaluated in the prediction of CAD. MBF and MFR were evaluated with and without MC and RAC (1: no MC/no RAC, 2: no MC/RAC, 3: MC/RAC). Results The area-under the receiver operating characteristics curve (AUC [95% confidence interval]) of stress MBF with MC/RAC was higher for minimal segment (0.89 [0.85–0.94]) than for minimal vessel (0.86 [0.81–0.92], p = 0.03) or global estimation (0.81 [0.75–0.87], p < 0.0001). The AUC of MFR with MC/RAC was higher for minimal segment (0.87 [0.81–0.93]) than for minimal vessel (0.83 [0.76–0.90], p = 0.014) or global estimation (0.77 [0.69–0.84], p < 0.0001). The AUCs of minimal segment stress MBF and MFR with MC/RAC were higher compared to those with no MC/RAC ( p < 0.001 for both) or no MC/no RAC ( p < 0.0001 for both). Conclusions Minimal segment MBF or MFR estimation with MC and RAC improves the diagnostic performance for obstructive CAD compared to global assessment.