Single Scan Rest/Stress Cardiac PET Imaging

描述（由申请人提供）：冠状动脉疾病（CAD）是西方世界导致死亡和残疾的主要原因。由于冠心病的信号事件通常是猝死或心肌梗死，因此大量的精力集中在开发新的无创成像技术上，以识别有冠心病风险和/或其破坏性后果的患者。采用新型血流示踪剂18F-BMS的正电子发射断层扫描（PET）是近年来出现的一种最有前途的方法，可用于检测和定位CAD，量化心肌血流，并利用门控成像技术表征壁运动异常。目前使用PET或单光子发射计算机断层扫描（SPECT）进行静息/应激心肌灌注成像的方法需要在静息和药理学或运动诱导的心脏应激下分别进行成像。这种重复成像需要后处理静应力图像共配准，耗时，效率低，对患者来说繁重，并且需要重复传输或CT扫描以进行衰减校正，从而增加对患者的辐射。在这个R21项目中，我们提出了一种基于双注射单扫描技术的18F-BMS心脏PET快速休息/应激成像的新方案。在这种方法中，只执行一次扫描来完成休息/压力协议。开始时，患者在静止状态下注射示踪剂，获取动态数据，然后在大约5-10分钟（最佳延迟时间待定）后，对患者施加药理学药物，在不中断扫描的情况下进行第二次给药（在压力下）。在第二次注入后，继续进行5-10分钟的数据采集（持续时间有待优化）。基于新的多态动力学室室模型，利用信号分离技术从数据中计算出分离的休息和应力图像以及灌注的定量参数。所提出的多状态单扫描技术具有几个优点。由于完成休息/应激心肌研究方案所需的时间较短，这将大大提高患者吞吐量和扫描仪利用率。由于患者不需要在休息和压力研究之间移动，因此估计冠状动脉血流储备（CFR）所需的静止和应激图像之间的共配准将得到改善。这种新方法对患者的好处还在于减少了辐射剂量，因为只需要进行一次x射线CT扫描。在分离休息和压力信号时，所提出的信号分离算法比目前使用的简单背景减法技术更强大。虽然在这项工作中，我们专注于心脏18F-BMS，但在这项资助下开发的技术也将直接适用于其他示踪剂的心脏成像。通过提供一种更快、更安全、更有效的PET定量灌注成像方法，多状态心脏PET成像在改善心脏病患者护理方面具有巨大的潜力。

DESCRIPTION (provided by applicant): Coronary artery disease (CAD) is the leading cause of mortality and disability in the western world. Since the signal event of CAD is often sudden death or myocardial infarction, great energy has been focused on developing new noninvasive imaging technologies to identify patients at risk for CAD and/or its devastating consequences. Positron emission tomography (PET) with the new flow tracer 18F-BMS is one of the most promising methods for detecting and localizing CAD, quantifying myocardial blood flow, and characterizing wall motion abnormalities using gated imaging techniques that have emerged in recent years. Current approaches to rest/stress myocardial perfusion imaging with either PET or Single-Photon Emission Computed Tomography (SPECT) require separate imaging at rest and under pharmacologic- or exercise-induced cardiac stress. Such repeat imaging requires post-processing rest-stress image coregistration, is time-consuming, inefficient, onerous to the patient, and requires repeated transmission or CT scans needed for attenuation correction that increase radiation does to the patient. Under this R21 project, we propose a new protocol for 18F-BMS cardiac PET based on a dual-injection single-scan technique for rapid rest/stress imaging. In this approach only a single scan is performed to complete the rest/stress protocol. At the beginning patient is injected with tracer at rest, dynamic data is acquired, and then after about 5-10 minutes (optimal delay to be determined) patient is stressed with the pharmacologic agent and a second administration of tracer (at stress) is performed without interrupting the scanning. Following the second injection, data acquisition is continued for another 5-10 minutes (duration to be optimized). Separate rest and stress images and quantitative parameters of perfusion are calculated from the data using signal separation techniques based on new multi-state kinetic compartmental models. The proposed multi-state single-scan technique offers several advantages. It would substantially increase patient throughput and scanner utilization due to the short time needed for completing the rest/stress myocardial study protocol. The coregistration between images at rest and stress needed for estimation of coronary flow reserve (CFR) would be improved because patients are not moved between rest and stress studies. The new approach also comes with benefits to the patient in reduced radiation dose because only one x-ray CT scan is necessary. The proposed signal-separation algorithms are more powerful than the simple background subtraction technique currently being employed when separating rest and stress signals. Although in this work we concentrate on cardiac 18F-BMS, the techniques developed under this grant will also be directly applicable to cardiac imaging with other tracers. Multi-state cardiac PET imaging has great potential to improve cardiac patient care by providing a faster, safer, and more effective way of performing quantitative perfusion imaging with PET. PUBLIC HEALTH RELEVANCE: This project describes a novel clinical protocol for imaging patients for cardiac abnormalities using Positron Emission Tomography with novel PET tracer. It increases patient throughput, reduces cost of performing rest/stress PET perfusion scans, reduces radiation dose, and improves accuracy of diagnoses of cardiac diseases.