Dependency of cardiac rubidium-82 imaging quantitative measures on age, gender, vascular territory, and software in a cardiovascular normal population

Recent technological improvements to PET imaging equipment combined with the availability of software optimized to calculate regional myocardial blood flow (MBF) and myocardial flow reserve (MFR) create a paradigm shifting opportunity to provide new clinically relevant quantitative information to cardiologists. However, clinical interpretation of the MBF and MFR is entirely dependent upon knowledge of MBF and MFR values in normal populations and subpopulations. This work reports Rb-82-based MBF and MFR measurements for a series of 49 verified cardiovascularly normal subjects as a preliminary baseline for future clinical studies. Forty-nine subjects (24F/25M, ages 41-69) with low probability for coronary artery disease and with normal exercise stress test were included. These subjects underwent rest/dipyridamole stress Rb-82 myocardial perfusion imaging using standard clinical techniques (40 mCi injection, 6-minute acquisition) using a Siemens Biograph 40 PET/CT scanner with high count rate detector option. List mode data was rehistogrammed into 26 dynamic frames (12 x 5 seconds, 6 x 10 seconds, 4 x 20 seconds, 4 x 40 seconds). Cardiac images were processed, and MBF and MFR calculated using Siemens syngo MBF, PMOD, and FlowQuant software using a single compartment Rb-82 model. Global myocardial blood flow under pharmacological stress for the 24 females as measured by PMOD, syngo MBF, and FlowQuant were 3.10 +/- A 0.72, 2.80 +/- A 0.66, and 2.60 +/- A 0.63 mL center dot minute(-1)center dot g(-1), and for the 25 males was 2.60 +/- A 0.84, 2.33 +/- A 0.75, 2.15 +/- A 0.62 mL center dot minute(-1)center dot g(-1), respectively. Rest flows for PMOD, syngo MBF, and FlowQuant averaged 1.32 +/- A 0.42, 1.20 +/- A 0.33, and 1.06 +/- A 0.38 mL center dot minute(-1)center dot g(-1) for the female subjects, and 1.12 +/- A 0.29, 0.90 +/- A 0.26, and 0.85 +/- A 0.24 mL center dot minute(-1)center dot g(-1) for the males. Myocardial flow reserves for PMOD, syngo MBF, and FlowQuant for the female normals were calculated to be 2.50 +/- A 0.80, 2.53 +/- A 0.67, 2.71 +/- A 0.90, and 2.50 +/- A 1.19, 2.85 +/- A 1.19, 2.94 +/- A 1.31 mL center dot minute(-1)center dot g(-1) for males. Quantitative normal MBF and MFR values averaged for age and sex have been compiled for three commercial pharmacokinetic software packages. The current collection of data consisting of 49 subjects resulted in several statistically significant conclusions that support the need for a software specific, age, and sex-matched database to aid in interpretation of quantitative clinical myocardial perfusion studies.