ABSTRACT
Myocardial perfusion imaging using positron emission tomography (PET) constitutes a non-invasive diagnostic procedure that provides crucial diagnostic and prognostic insights in the context of coronary artery disease. It enables the identification of microvascular circulation disorders in the early phases. The utilization of myocardial PET perfusion studies is on the rise, primarily owing to significant advantages compared to single photon emission tomography. These advantages include superior resolution and sensitivity, robust attenuation correction, reduced radiation exposure, and the capability for absolute quantification of stress and rest myocardial blood flow. This guide endeavors to establish standardized protocols for quantitative myocardial PET perfusion imaging and aims to provide information concerning their clinical applications and interpretation, aligning with international guidelines and relevant literature.
Keywords:
Positron emission tomography, myocardial blood flow, quantitative imaging
References
1
Husmann L, Wiegand M, Valenta I, et al. Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography. Int J Cardiovasc Imaging 2008;24:511-518.
2
Dilsizian V, Bacharach SL, Beanlands RS, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol 2016;23:1187-1226.
3
Case JA, deKemp RA, Slomka PJ, Smith MF, Heller GV, Cerqueira MD. Status of cardiovascular PET radiation exposure and strategies for reduction: an information statement from the Cardiovascular PET Task Force. J Nucl Cardiol 2017;24:1427-1439.
4
Brunken RC, Schelbert HR. Positron emission tomography in clinical cardiology. Cardiol Clin 1989;7:607-629.
5
Renaud JM, Yip K, Guimond J, et al. Characterization of 3-dimensional PET systems for accurate quantification of myocardial blood flow. J Nucl Med 2017;58:103-109.
6
Maddahi J, Packard RRS. Cardiac PET perfusion tracers: current status and future directions. Semin Nucl Med 2014;44:333-343.
7
Hsu B. PET tracers and techniques for measuring myocardial blood flow in patients with coronary artery disease. J Biomed Res 2013;27:452-459.
8
Armstrong IS, Tonge CM, Arumugam P. Assessing time-of-flight signal-to-noise ratio gains within the myocardium and subsequent reductions in administered activity in cardiac PET studies. J Nucl Cardiol 2019;26:405-412.
9
Hsu DFC, Ilan E, Peterson WT, Uribe J, Lubberink M, Levin CS. Studies of a next-generation silicon-photomultiplier-based timeof-flight PET/CT system. J Nucl Med 2017;58:1511-1518.
10
Barbosa Fde G, von Schulthess G, Veit-Haibach P. Workflow in SimultaneousPET/MRI. Semin Nucl Med 2015;45:332-344.
11
van Sluis J, de Jong J, Schaar J, et al. Performance characteristics of the digital biograph vision PET/CT system. J Nucl Med 2019;60:1031-1036.
12
Shaw LJ, Blankstein R. Next Step for Hybrid PET-CT Imaging: Automation of CAC Scores. JACC Cardiovasc Imaging 2023;16:688-690.
13
Bergmann SR, Fox KA, Rand AL, et al. Quantification of regional myocardial blood flow in vivo with H2 15O. Circulation 1984;70:724-733.
14
Sánchez-Crespo A, Andreo P, Larsson SA. Positron flight in human tissues and its influence on PET image spatial resolution. Eur J Nucl Med Mol Imaging 2004;31:44-51.
15
Yamamoto Y, De SiSVa R, Rhodes CG, et al. A new strategy assessment of viable myocardium and regional myocardial blood flow using 15O-water and dynamic positron emission tomography. Circulation 1992;86:167-178.
16
Mattsson S, Johansson L, Leide Svegborn S, et al. Radiation to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances. Ann ICRP 2015;44(Suppl 2):7-321.
17
Goldstein RA, Mullani NA, Marani SK, Fisher DJ, Gould KL, O’Brien HA Jr. Myocardial perfusion with rubidium-82. II. Effects of metabolic and pharmacologic interventions. J Nucl Med 1983;24:907-915.
18
Selwyn AP, AllanRM, L’AbbateA, et al. Relation between regional myocardial uptake of rubidium-82 and perfusion: absolute reduction of cation uptake in ischemia. Am J Cardiol 1982;50:112-121.
19
Go RT, Marwick TH, MacIntyre WJ, et al. A prospective comparison of rubidium-82 PET and thallium-201 SPECT myocardial perfusion imaging utilizing a single dipyridamole stress in the diagnosis of coronary artery disease. J Nucl Med 1990;31:1899-1905.
20
Sciagrà R, Lubberink M, Hyafil F, et al. EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2021;48:1040-1069.
21
Hutchins GD, Schwaiger M, Rosenspire KC, Krivokapich J, Schelbert H, Kuhl DE. Noninvasive quantification of regional blood flow in the human heart using N-13 ammonia and dynamic positron emission tomographic imaging. J Am Coll Cardiol 1990;15:1032-1042.
22
Dilsizian V, Taillefer R. Journey in evolution of nuclear cardiology: Will there be another quantum leap with the F-18 labeled myocardial perfusion tracers? JACC Cardiovasc Imaging 2012;5:1269-1284.
23
Maddahi J. Properties of an ideal PET perfusion tracer: new PET tracer cases and data. J Nucl Cardiol 2012;19(Suppl 1):S30-S37.
24
Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology pro- cedures: Stress, protocols, and tracers. J Nucl Cardiol 2016;23:606-639.
25
Goudarzi B, Fukushima K, Bravo P, Merrill J, Bengel FM. Comparison of the myocardial blood flow response to regadenoson and dipyridamole: a quantitative analysis in patients referred for clinical 82Rb myocardial perfusion PET. Eur J Nucl Med Mol Imaging 2011;38:1908-1916.
26
Souvatzoglou M, Bengel F, Busch R, et al. Attenuation correction in cardiac PET/CT with three different CT protocols: a comparison with conventional PET. Eur J Nucl Med Mol Imaging 2007;34:1991-2000.
27
Søndergaard HM, Madsen MM, Boisen K, et al. Evaluation of iterative reconstruction (OSEM) versus filtered back-projection omogra assessment of myocardial glucose uptake and myocardial perfusion using dynamic PET. Eur J Nucl Med Mol Imaging 2007;34:320-329.
28
Hunter CRRN, Klein R, Beanlands RS, deKemp RA. Patient motion effects on the quantification of regional myocardial blood flow with dynamic PET imaging. Med Phys 2016;43:1829.
29
Cerqueira MD, Weissman NJ, Dilsizian V, et al. American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. Circulation 2002;105:539-542.
30
Brophey MD, Farukhi IM, Castanon R, DeLaPena R, Bradshaw L, Banerjee S. Accuracy of 82Rb PET/CT myocardial perfusion imaging with regadenoson stress, including 3-year clinical outcomes. J Nucl Med Technol 2017;45:75-81.
31
Hsiao E, Ali B, Blankstein R, et al. Detection of obstructive coronary artery disease using regadenoson stress and 82Rb PET/CT myocardial perfusion imaging. J Nucl Med 2013;54:1748-1754.
32
Dorbala S, Hachamovitch R, Curillova Z, et al. Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest SVEF. JACC Cardiovasc Imaging 2009;2:846-854.
33
Bravo PE, Chien D, Javadi M, Merrill J, Bengel FM. Reference ranges for SVEF and SV volumes from electrocardiographically gated 82Rb cardiac PET/CT using commercially available software. J Nucl Med 2010;51:898-905.
34
Dorbala S, Vangala D, Sampson U, Limaye A, Kwong R, Di Carli MF. Value of vasodilator left ventricular ejection fraction reserve in evaluating the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: an 82Rb PET/CT study. J Nucl Med 2007;48:349-358.
35
Yalçin H, Valenta I, Yalçin F, et al. Effect of diffuse subendocardial hypoperfusion on left ventricular cavity size by 13N-ammonia perfusion PET in patients with hypertrophic cardiomyopathy. Am J Cardiol 2016;118:1908-1915.
36
Danad I, Uusitalo V, Kero T, et al. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease: cutoff values and diagnostic accuracy of quantitative [(15)O]H2O PET imaging. J Am Coll Cardiol 2014;64:1464-1475.
37
El Fakhri G, Sitek A, Guerin B, Kijewski MF, Di Carli MF, Moore SC. Quantitative dynamic cardiac 82Rb PET using generalized factor and compartment analyses. J Nucl Med 2005;46:1264-1271.
38
Harms HJ, Knaapen P, de Haan S, Halbmeijer R, Lammertsma AA, Lubberink M. Automatic generation of absolute myocardial blood flow images using [15O]H2O and a clinical PET/CT scanner. Eur J Nucl Med Mol Imaging 2011;38:930-939.
39
Harms HJ, De Haan S, Knaapen P, Allaart CP, Lammertsma AA, Lubberink M. Parametric images of myocardial viability using a single 15O-H2O PET/CT scan. J Nucl Med 2011;52:745-749.
40
Yoshida K, Mullani N, Gould KL. Coronary flow and flow reserve by PET simplified for clinical applications using rubidium-82 or nitrogen-13-ammonia. J Nucl Med 1996;37:1701-1712.
41
Monroy-Gonzalez AG, Juarez-Orozco LE, Han C, et al. Software reproducibility of myocardial blood flow and flow reserve quantification in ischemic heart disease: A 13N-ammonia PET study. J Nucl Cardiol 2020;27:1225-1233.
42
Bol A, Melin JA, Vanoverschelde JL, et al. Direct comparison of [13N]ammonia and [15O]water estimates of perfusion with quantification of regional myocardial blood flow by microspheres. Circulation 1993;87:512-525.
43
Rajaram M, Tahari AK, Lee AH, et al. Cardiac PET/CT misregistration causes significant changes in estimated myocardial blood flow. J Nucl Med 2013;54:50-54.
44
Piccinelli M, Votaw JR, Garcia EV. Motion correction and its impact on absolute myocardial blood flow measures with PET. Curr Cardiol Rep 2018;20:34.
45
Koenders SS, van Dijk JD, Jager PL, Ottervanger JP, Slump CH, van Dalen JA. Impact of regadenoson-induced myocardial creep on dynamic rubidium-82 PET myocardial blood flow quantifica- tion. J Nucl Cardiol 2019;26:719-728.
46
Votaw JR, Packard RRS. Technical aspects of acquiring and mea- suring myocardial blood flow: method, technique, and QA. J Nucl Cardiol 2018;25:665-670.
47
Campisi R, Czernin J, Karpman HL, Schelbert HR. Coronary vasodilatory capacity and flow reserve in normal myocardium supplied by bypass grafts late after surgery. Am J Cardiol 1997;80:27-31.
48
Paz Y, Morgenstern R, Weinberg R, et al. Relation of coronary flow reserve to other findings on pos- itron emission tomography myocardial perfusion imaging and left heart catheterization in patients with end-stage renal disease being evaluated for kidney transplant. Am J Cardiol 2017;120:1909-1912.
49
Driessen RS, van Timmeren JE, Stuijfzand WJ, et al. Measurement of SV volumes and function using oxygen-15 water-gated PET and comparison with CMR imaging. JACC Cardiovasc Imaging 2016;9:1472-1474.
50
Tout D, Tonge C, Muthu S, Arumugam P. Assessment of a pro- tocol for routine simultaneous myocardial blood flow measurement and standard myocardial perfusion imaging with rubidium- 82 on a high-count rate positron emission tomography system. Nucl Med Commun 2012;33:1202-1211.
51
Klein R, Adler A, Beanlands RS, deKemp RA. Precision- controlled elution of a 82Sr/82Rb generator for cardiac perfusion imaging with positron emission tomography. Phys Med Biol 2007;52:659-673.
52
Armstrong IS, Memmott MJ, Tonge CM, Arumugam P. The impact of prompt gamma compensation on myocardial blood flow measurements with rubidium-82 dynamic PET. J Nucl Cardiol 2018;25:596-605.
53
Brown TL, Voicu C, Merrill J, Bengel FM. Pathophysiologic correlates of 82Rb biodistribution in cardiac PET/CT. Eur J Nucl Med Mol Imaging 2011;38:479-484.
54
Alzahrani AH, Arasaratnam P, Massalha S, et al. Effect of proton pump inhibitors on Rubidium-82 gastric uptake using positron emission tomography myocardial perfusion imaging. J Nucl Cardiol 2020;27:1443-1451.
55
Rasmussen T, Kjær A, Hasbak P. Stomach interference in 82Rb- PET myocardial perfusion imaging. J Nucl Cardiol 2019;26:1934-1942.
56
Klingensmith WC 3rd, Noonan C, Goldberg JH, Buchwald D, Kimball JT, Manson SM. Decreased perfusion in the lateral wall of the left ventricle in PET/CT studies with 13N-ammonia: evaluation in healthy adults. J Nucl Med Technol 2009;37:215-219.
57
Steffen DA, Giannopoulos AA, Grossmann M, et al. “Apical thinning”: Relations between myocardial wall thickness and apical left ventricular tracer uptake as assessed with positron emission tomography myocardial perfusion imaging. J Nucl Cardiol 2020;27:452-460.
58
Kagaya A, Fukuda H, Yoshida K, et al. Pulmonary kinetics of 13N-ammonia in smoking subjects – a quantitative study using dynamic PET. Kaku Igaku 1992;29:1099-1106.
59
Markousis-Mavrogenis G, Juárez-Orozco LE, Alexanderson E. Residual activity correction in quantitative myocardial perfusion 13N-ammonia PET imaging: a study in post-MI patients. Hell J Cardiol 2017;58:245-249.
60
Opstal TSJ, Knol RJJ, Cornel JH, Wondergem M, van der Zant FM. Myocardial blood flow and myocardial flow reserve values in 13N-ammonia myocardial perfusion PET/CT using a time- efficient protocol in patients without coronary artery disease. Eur J Hybrid Imaging 2018;2:11.
61
Danad I, Raijmakers PG, Appelman YE, et al. Coronary risk factors and myocardial blood flow in patients evaluated for coronary artery disease: a quantitative [15O]H2O PET/CT study. Eur J Nucl Med Mol Imaging 2012;39:102-112.
62
Kajander S, Joutsiniemi E, Saraste M, et al. Cardiac positron emission tomography/ computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation 2010;122:603-613.
63
Bom MJ, van Diemen PA, Driessen RS, et al. Prognostic value of [15O]H2O positron emission tomography-derived global and regional myocardial perfusion. Eur Heart J Cardiovasc Imaging 2020;21:777-786.
64
Joutsiniemi E, Saraste A, Pietilä M, et al. Absolute flow or myocardial flow reserve for the detection of significant coronary artery disease? Eur Heart J Cardiovasc Imaging 2014;15:659-665.
65
Berti V, Sciagrà R, Neglia D, et al. Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina. Eur J Nucl Med Mol Imaging 2016;43:1522-1529.
66
Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ ASNC Committee to revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-1333.
67
Mc Ardle BA, Dowsley TF, deKemp RA, Wells GA, Beanlands RS. Does rubidium-82 PET have superior accuracy to SPECT perfusion imaging for the diagnosis of obstructive coronary disease?: a systematic review and meta-analysis. J Am Coll Cardiol 2012;60:1828-1837.
68
Bateman TM, Heller GV, McGhie AI, et al. Diagnostic accuracy of rest/stress ECG- gated Rb-82 myocardial perfusion PET: comparison with ECG- gated Tc-99m sestamibi SPECT. J Nucl Cardiol 2006;13:24-33.
69
Stewart RE, Schwaiger M, Molina E, et al. Comparison of rubidium-82 positron emission tomography and thallium-201 SPECT imaging for detection of coronary artery disease. Am J Cardiol 1991;67:1303-1310.
70
Yoshinaga K, Chow BJ, Williams K, et al. What is the prognostic value of myocardial per- fusion imaging using rubidium-82 positron emission tomography? J Am Coll Cardiol 2006;48:1029-1039.
71
Hyafil F, Chequer R, Sorbets E, et al. Head-to-head comparison of the diagnostic performances of rubidium-PET and SPECT with CZT camera for the detection of myocardial ischemia in a population of women and overweight individuals. J Nucl Cardiol 2020;27:755-768.
72
Anagnostopoulos C, Almonacid A, El Fakhri G, et al. Quantitative relationship between coronary vasodilator reserve assessed by 82Rb PET imaging and coronary artery stenosis severity. Eur J Nucl Med Mol Imaging 2008;35:1593-1601.
73
Parkash R, deKemp RA, Ruddy TD, et al. Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease. J Nucl Cardiol 2004;11:440-449.
74
Naya M, Murthy VL, Taqueti VR, et al. Preserved coronary flow reserve effectively excludes high- risk coronary artery disease on angiography. J Nucl Med 2014;55:248-255.
75
Murthy VL, Naya M, Foster CR, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation 2011;124:2215-2224.
76
Ziadi MC, Dekemp RA, Williams KA, et al. Impaired myocardial flow reserve on rubidium-82 pos- itron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol 2011;58:740-748.
77
Dorbala S, Di Carli MF, Beanlands RS, et al. Prognostic value of stress myocardial perfu- sion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol 2013;61:176-184.
78
Nohara R, Kambara H, Kawai C, et al. Exercise 13NH3- positron emission computed tomography (PET) versus exercise single photon emission computed tomography (SPECT). J Cardiogr Suppl 1987;12:107-116.
79
Muzik O, Duvernoy C, Beanlands RS, et al. Assessment of diagnostic performance of quantitative flow measurements in normal subjects and patients with angiographically documented coronary artery disease by means of nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol 1998;31:534-540.
80
Schindler TH, Campisi R, Dorsey D, et al. Effect of hormone replacement therapy on vasomo- tor function of the coronary microcirculation in post-menopausal women with medically treated cardiovascular risk factors. Eur Heart J 2009;30:978-986.
81
Quercioli A, Pataky Z, Vincenti G, et al. Elevated endocannabinoid plasma levels are ssociated with coronary circulatory dysfunction in obesity. Eur Heart J 2011;32:1369-1378.
82
Quercioli A, Montecucco F, Pataky Z, et al. Improvement in coronary circulatory function in morbidly obese individuals after gastric bypass-induced weight loss: relation to alterations in endocannabinoids and adipocytokines. Eur Heart J 2013;34:2063-2073.
83
Herzog BA, Husmann L, Valenta I, et al. Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography added value of cor-onary flow reserve. J Am Coll Cardiol 2009;54:150-156.
84
Tio RA, Dabeshlim A, Siebelink HM, et al. Comparison between the prognostic value of left ventricular function and myocardial perfusion reserve in pa- tients with ischemic heart disease. J Nucl Med 2009;50:214-219.
85
Slart RH, Zeebregts CJ, Hillege HL, et al. Myocardial perfusion reserve after a PET- driven revascularization procedure: a strong prognostic factor. J Nucl Med 2011;52:873-879.
86
Hajjiri MM, Leavitt MB, Zheng H, Spooner AE, Fischman AJ, Gewirtz H. Comparison of positron emission tomography mea- surement of adenosine-stimulated absolute myocardial blood flow versus relative myocardial tracer content for physiological assessment of coronary artery stenosis severity and location. JACC Cardiovasc Imaging 2009;2:751-758.
87
Fiechter M, Ghadri JR, Gebhard C, et al. Diagnostic value of 13N-ammonia myocardial perfusion PET: added value of myocardial flow reserve. J Nucl Med 2012;53:1230-1234.
88
Morton G, Chiribiri A, Ishida M, et al. Quantification of absolute myocardial perfusion in patients with coronary artery disease: comparison be tween cardiovascular magnetic resonance and positron emission tomography. J Am Coll Cardiol 2012;60:1546-1555.
89
Sciagrà R, Passeri A, Bucerius J, et al. Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016;43:1530-1545.
90
Ziadi MC, Dekemp RA, Williams K, et al. Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? J Nucl Cardiol 2012;19:670-680.
91
Murthy VL, Naya M, Taqueti VR, et al. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation 2014;129:2518-2527.
92
Taqueti VR, Shaw LJ, Cook NR, et al. Excess cardiovascular risk in women relative to men referred for coronary angiography is associated with severely im- paired coronary flow reserve, not obstructive disease. Circulation 2017;135:566-577.
93
Dorbala S, Di Carli MF. Cardiac PET perfusion: prognosis, risk stratification, and clinical management. Semin Nucl Med 2014;44:344-357.
94
Majmudar MD, Murthy VL, Shah RV, et al. Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes. Eur Heart J Cardiovasc Imaging 2015;16:900-909.
95
Castagnoli H, Ferrantini C, Coppini R, et al. Role of quantitative myocardial positron emission tomog- raphy for risk stratification in patients with hypertrophic cardio- myopathy: a 2016 reappraisal. Eur J Nucl Med Mol Imaging 2016;43:2413-2422.
96
Murthy VL, Naya M, Foster CR, et al. Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes mellitus. Circulation 2012;126:1858-1868.
97
Murthy VL, Naya M, Foster CR, et al. Coronary vascular dysfunction and prognosis in patients with chronic kidney disease. JACC Cardiovasc Imaging 2012;5:1025-1034.
98
Monroy-Gonzalez AG, Tio RA, de Groot JC, et al. Long-term prognostic value of quantitative myocardial perfusion in patients with chest pain and normal coronary arteries. J Nucl Cardiol 2019;26:1844-1852.
99
Gould KL, Johnson NP, Kaul S, et al. Patient selection for elective revascularization to reduce myocardial infarction and mortality: new lessons from randomized trials, coronary physiology, and statistics. Circ Cardiovasc Imaging 2015;8.
100
Flotats A, Knuuti J, Gutberlet M, et al. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging 2011;38:201-221.
101
Dorbala S, Di Carli MF, Delbeke D, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med 2013;54:1485-1507.
102
Gaudieri V, Acampa W, Rozza F, et al. Coronary vascular function in patients with resistant hypertension and normal myocardial perfusion: a propensity score analysis. Eur Heart J Cardiovasc Imaging 2019;20:949-958.
103
Nensa F, Bamberg F, Rischpler C, et al. Hybrid cardiac imaging using PET/MRI: a joint position statement by the European Society of Cardiovascular Radiology (ESCR) and the European Association of Nuclear Medicine (EANM). Eur Radiol 2018;28:4086-4101.
104
Menke J, Kowalski J. Diagnostic accuracy and utility of coronary CT angiography with consideration of unevaluable results: a systematic review and multivariate Bayesian random-effects meta- analysis with intention to diagnose. Eur Radiol 2016;26:451-458.
105
Cheruvu C, Precious B, Naoum C, et al. Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: results from the 5 year follow-up of the CONFIRM International Multicenter Registry. J Cardiovasc Comput Tomogr 2016;10:22-27.
106
Nielsen LH, Bøtker HE, Sørensen HT, et al. Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study. Eur Heart J 2016:ehw548.
107
Budoff MJ, Mayrhofer T, Ferencik M, et al. Prognostic value of coronary artery calcium in the PROMISE study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation 2017;136:1993-2005.
108
Thomassen A, Petersen H, Johansen A, et al. Quantitative myocardial perfusion by O-15- water PET: individualized vs. standardized vascular territories. Eur Heart J Cardiovasc Imaging 2015;16:970-976.
109
Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the Management of Stable Coronary Artery Disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003.
110
Hecht HS, Cronin P, Blaha MJ, et al. 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: a report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. J Thorac Imaging 2017;32:W54-W66.
111
Reyes E, Stirrup J, Roughton M, D’Souza S, Underwood SR, Anagnostopoulos C. Attenuation of adenosine-induced myocardi- al perfusion heterogeneity by atenolol and other cardioselective beta-adrenoceptor blockers: a crossover myocardial perfusion im- aging study. J Nucl Med 2010;51:1036-1043.
112
Kassamali RH, Kim DH, Patel H, et al. Safety of an i.v. b-adrenergic blockade protocol for heart rate optimization before coronary CT angiography. AJR Am J Roentgenol 2014;203:759-762.
113
Gaemperli O, Schepis T, Kalff V, et al. Validation of a new cardiac image fusion software for three- dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography. Eur J Nucl Med Mol Imaging 2007;34:1097-1106.
114
Manka R, Kuhn FP, Kuest SM, Gaemperli O, Kozerke S, Kaufmann PA. Hybrid cardiac magnetic resonance/computed to- mographic imaging: first fusion of three-dimensional magnetic resonance perfusion and low-dose coronary computed tomographic angiography. Eur Heart J 2011;32:2625.
115
Gould KL, Pan T, Loghin C, Johnson NP, Guha A, Sdringola S. Frequent diagnostic errors in cardiac PET/CT due to misregistration of CT attenuation and emission PET images: a definitive analysis of causes, consequences, and corrections. J Nucl Med 2007;48:1112-1121.
116
Gimelli A, Achenbach S, Buechel RR, et al. Strategies for radiation dose reduction in nu- clear cardiology and cardiac computed tomography imaging: a report from the European Association of Cardiovascular Imaging (EACVI), the Cardiovascular Committee of European Association of Nuclear Medicine (EANM), and the European Society of Cardiovascular Radiology (ESCR). Eur Heart J 2018;39:286-296.
117
Rizvi A, Han D, Danad I, et al. Diagnostic performance of hybrid cardiac imaging methods for assessment of obstructive coronary artery disease compared with stand-alone coronary computed tomography angiography: a meta- analysis. JACC Cardiovasc Imaging 2018;11:589-599.
118
Danad I, Raijmakers PG, Driessen RS, et al. Comparison of coronary CT angiography, SPECT, PET, and hybrid imaging for diagnosis of ischemic heart disease deter- mined by fractional flow reserve. JAMA Cardiol 2017;2:1100-1107.
119
Santana CA, Garcia EV, Faber TL, et al. Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary an- giography. J Nucl Cardiol 2009;16:201-211.
120
Liga R, Vontobel J, Rovai D, et al. Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population. Eur Heart J Cardiovasc Imaging 2016;17:951-960.
121
Gräni C, Benz DC, Possner M, et al. Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies. Congenit Heart Dis 2017;12:49-57.
122
Maaniitty T, Jaakkola S, Saraste A, Knuuti J. Hybrid coronary computed tomography angiography and positron emission tomography myocardial perfusion imaging in evaluation of recurrent symptoms after coronary artery bypass grafting. Eur Heart J Cardiovasc Imaging 2019;20:1298-1304.
123
Stenström I, Maaniitty T, Uusitalo V, et al. Frequency and angiographic characteristics of coronary microvascular dysfunction in stable angina: a hybrid imaging study. Eur Heart J Cardiovasc Imaging 2017;18:1206-1213.
124
Maaniitty T, Stenström I, Bax JJ, et al. Prognostic value of coronary CT angiography with selective PET perfusion imaging in coronary artery disease. JACC Cardiovasc Imaging 2017;10:1361-1370.
125
Schepis T, Gaemperli O, Koepfli P, et al. Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med 2007;48:1424-1430.
126
Assante R, Zampella E, Arumugam P, et al. Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/ CT imaging in patients with suspected coronary artery disease. J Nucl Cardiol 2017;24:494-501.
127
Imbriaco M, Nappi C, Ponsiglione A, et al. Hybrid positron emission tomography-magnetic resonance imaging for assessing different stages of cardiac impairment in patients with Anderson-Fabry disease: AFFINITY study group. Eur Heart J Cardiovasc Imaging. 2019;20:1004-1011.
128
Nappi C, Altiero M, Imbriaco M, et al. First experience of simultaneous PET/MRI for the early detection of cardiac invoSVement in patients with Anderson-Fabry disease. Eur J Nucl Med Mol Imaging 2015;42:1025-1031.
129
Nensa F, Poeppel TD, Beiderwellen K, et al. Hybrid PET/MR imaging of the heart: feasi- bility and initial results. Radiology 2013;268:366-373.
130
Rischpler C, Langwieser N, Souvatzoglou M, et al. PET/MRI early after myocardial infarction: evaluation of viability with late gadolinium nhancement transmurality vs. 18F-FDG uptake. Eur Heart J Cardiovasc Imaging 2015;16:661-669.
131
Maddahi J, Czernin J, Lazewatsky J, et al. Phase I, first-in-human study of BMS747158, a novel F-18 labeled tracer for myocardial perfusion PET imaging: dosimetry, biodistribution, safety, and imaging characteristics af- ter a single injection at rest. J Nucl Med 2011;52:1490-1498.
132
Maddahi J, Bengel F, Czernin J, et al. Dosimetry, biodistribution, and safety of flurpiridaz F 18 in healthy subjects undergoing rest and exercise or pharmacological stress PET myocardial perfusion imaging. J Nucl Cardiol 2019;26:2018-2030.
133
Sherif HM, Nekolla SG, Saraste A, et al. Simplified quantification of myocardial flow reserve with flurpiridaz F 18: validation with microspheres in a pig model. J Nucl Med 2011;52:617-624.
134
Berman DS, Maddahi J, Tamarappoo BK, et al. Phase II safety and clinical comparison with single-photon emission computed tomography myocardial perfu- sion imaging for detection of coronary artery disease: flurpiridaz F 18 positron emission tomography. J Am Coll Cardiol 2013;61:469-477.
135
Moody JB, Poitrasson-Rivière A, Hagio T, et al. Added value of myocardial blood flow using 18F-flurpiridaz PET to diagnose coronary artery disease: The flurpiridaz 301 trial. J Nucl Cardiol 2021;28:2313-2329.
