Circulation, Vol 80, 1328-1337, Copyright © 1989 by American Heart Association
J Krivokapich, GT Smith, SC Huang, EJ Hoffman, O Ratib, ME Phelps and HR Schelbert
Positron emission tomography (PET) was applied to the measurement of
myocardial perfusion using the perfusion tracer 13N-labeled ammonia. 13N
ammonia was delivered intravenously to 13 healthy volunteers both at rest
and during supine bicycle exercise. Dynamic PET imaging was obtained in
three cross-sectional planes for 10 minutes commencing with each injection.
The left ventricle was divided into eight sectors, and a small region of
interest was assigned to the left ventricular blood pool to obtain the
arterial input function. The net extraction of 13N ammonia was obtained for
each sector by dividing the tissue 13N concentration at 10 minutes by the
integral of the input function from the time of injection to 10 minutes.
With this approach for calculating net extractions, rest and exercise net
extractions were not significantly different from each other. To obviate
possible overestimation of the true 13N ammonia input function by
contamination by 13N-labeled compounds other than 13N ammonia or by
spillover from myocardium into blood pool, the net extractions were
calculated using only the first 90 seconds of the blood and tissue
time-activity curves. This approach for calculating net extractions yielded
significant differences between rest and exercise, with an average ratio of
exercise to rest of 1.38 +/- 0.34. Nonetheless, the increase was less than
predicted from the average 2.7-2.8-fold increase in double product at peak
exercise or the 1.7-fold increase in double product at 1 minute after
exercise. However, when the first 90 seconds of dynamic data were fit with
a two compartment tracer kinetic model, average perfusion rates of 0.75 +/-
0.43 ml/min/g at rest and 1.50 +/- 0.74 ml/min/g with exercise were
obtained. This average increase in perfusion of 2.2-fold corresponded to
similar average increases in double product. Thus, the noninvasive
technique of PET imaging with 13N ammonia shows promise for future
applications in determining absolute flows in patients with coronary artery
disease.
ARTICLES
13N ammonia myocardial imaging at rest and with exercise in normal volunteers. Quantification of absolute myocardial perfusion with dynamic positron emission tomography
Department of Medicine, UCLA School of Medicine 90024-1679.
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