No need for frame-wise attenuation correction in dynamic Rubidium-82 PET for myocardial blood flow quantification

  • J. D. van DijkEmail author
  • P. L. Jager
  • J. P. Ottervanger
  • C. H. Slump
  • J. A. van Dalen
Original Article



Regadenoson-induced stress causes a repositioning of the heart, myocardial creep, in half of the patients undergoing Rubidium-82 (Rb-82) positron emission tomography (PET). As a result, misalignment of dynamic PET and computer tomography (CT) may occur, possibly affecting CT-based attenuation correction (AC) and thereby PET-based myocardial blood flow (MBF) quantification. Our aim was to determine the need for frame-wise PET-CT AC to obtain reliable MBF measurements.


31 Out of 64 consecutive patients had myocardial creep during regadenoson-induced stress Rb-82 PET-CT and were included. Prior to PET image reconstruction, we applied two AC methods; single PET-CT alignment and frame-wise alignment in which PET time-frames with myocardial creep were individually co-registered with CT. The PET-CT misalignment was then quantified and MBFs for the three vascular territories and whole myocardium were calculated and compared between both methods.


The magnitude of misalignment due to myocardial creep was 13.8 ± 4.5 mm in caudal-cranial direction, 1.8 ± 2.1 mm in medial-lateral and 2.5 ± 1.8 mm in anterior-posterior direction. Frame-wise PET-CT registration did not result in different MBF measurements (P ≥ .07) and the magnitude of misalignment and MBF differences did not correlate (P ≥ .58).


There is no need for frame-wise AC in dynamic Rb-82 PET for MBF quantification. Single alignment seems sufficient in patients with myocardial creep.


Myocardial blood flow attenuation correction PET-CT registration PET rubidium 



Attenuation correction


Body mass index


Computer tomography


Myocardial perfusion imaging


Myocardial blood flow


Positron emission tomography




Standard deviation



None of the authors have anything to disclose.

Supplementary material

12350_2019_1654_MOESM1_ESM.pptx (396 kb)
Supplementary material 1 (PPTX 395 kb)


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Copyright information

© American Society of Nuclear Cardiology 2019
corrected publication 2019

Authors and Affiliations

  1. 1.Department of Nuclear MedicineIsala HospitalZwolleThe Netherlands
  2. 2.Department of Medical PhysicsIsala HospitalZwolleThe Netherlands
  3. 3.Department of CardiologyIsala HospitalZwolleThe Netherlands
  4. 4.MIRA: Institute for Biomedical Technology and Technical MedicineUniversity of TwenteEnschedeThe Netherlands

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