Blood pool and tissue phase patient motion effects on 82rubidium PET myocardial blood flow quantification
Patient motion can lead to misalignment of left ventricular volumes of interest and subsequently inaccurate quantification of myocardial blood flow (MBF) and flow reserve (MFR) from dynamic PET myocardial perfusion images. We aimed to identify the prevalence of patient motion in both blood and tissue phases and analyze the effects of this motion on MBF and MFR estimates.
We selected 225 consecutive patients that underwent dynamic stress/rest rubidium-82 chloride (82Rb) PET imaging. Dynamic image series were iteratively reconstructed with 5- to 10-second frame durations over the first 2 minutes for the blood phase and 10 to 80 seconds for the tissue phase. Motion shifts were assessed by 3 physician readers from the dynamic series and analyzed for frequency, magnitude, time, and direction of motion. The effects of this motion isolated in time, direction, and magnitude on global and regional MBF and MFR estimates were evaluated. Flow estimates derived from the motion corrected images were used as the error references.
Mild to moderate motion (5-15 mm) was most prominent in the blood phase in 63% and 44% of the stress and rest studies, respectively. This motion was observed with frequencies of 75% in the septal and inferior directions for stress and 44% in the septal direction for rest. Images with blood phase isolated motion had mean global MBF and MFR errors of 2%-5%. Isolating blood phase motion in the inferior direction resulted in mean MBF and MFR errors of 29%-44% in the RCA territory. Flow errors due to tissue phase isolated motion were within 1%.
Patient motion was most prevalent in the blood phase and MBF and MFR errors increased most substantially with motion in the inferior direction. Motion correction focused on these motions is needed to reduce MBF and MFR errors.
KeywordsMyocardial perfusion imaging: PET Coronary blood flow Coronary flow reserve Image artifacts Pharmacologic stress
Myocardial blood flow
Myocardial flow reserve
Positron emission tomography
Volume of interest
Left anterior descending
Right coronary artery
B.C. Lee, J.B. Moody, and A. Poitrasson-Rivière are employees of INVIA Medical Imaging Solutions. A.C. Melvin and R.L. Weinberg have no disclosures. J.R. Corbett and E.P. Ficaro are owners of INVIA Medical Imaging Solutions. V.L. Murthy has received consulting fees from Ionetix, Inc, and owns stock in General Electric and Cardinal Health and stock options in Ionetix, Inc. V.L. Murthy is supported by 1R01HL136685 from the National, Heart, Lung, Blood Institute, and research grants from INVIA Medical Imaging Solutions and Siemens Medical Imaging.
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