JNC: Splenic switch-off in [15O]H2O-positron emission tomography myocardial perfusion imaging using parametric blood flow images (Aug2024)-Splenic switch-off in [15O]H2O-positron emission tomography myocardial perfusion imaging using parametric blood flow images

Splenic switch-off in [15O]H2O-positron emission tomography myocardial perfusion imaging using parametric blood flow images

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The study conducted by Brorson et al. focused on evaluating the efficacy of splenic switch-off as an indicator of sufficient adenosine response during myocardial perfusion imaging (MPI) using PET imaging with [15O]H2O. The researchers investigated semi-quantitative and quantitative approaches to assess splenic switch-off using summed activity images and parametric blood flow images. The study included three cohorts of patients: one with sufficient adenosine response, another with suspected insufficient response undergoing a repeat MPI, and a third with follow-up coronary angiogram (CAG) after MPI.<br /><br />Results indicated that splenic switch-off was present in most patients with sufficient adenosine response, with parametric blood flow images showing superiority over summed activity images. A spleen stress/rest-ratio (SSR-ratio) of 0.90 was identified as a suitable cutoff for predicting the need for repeat MPI in patients with suspected insufficient adenosine response. Patients with an SSR-ratio of 0.90 on the initial MPI were less likely to benefit from a repeat MPI. However, patients with atrial fibrillation posed challenges in the assessment of adenosine response.<br /><br />The study demonstrated that quantitative assessment of splenic switch-off using parametric blood flow images is a reliable marker for adenosine response. The findings suggested that if the SSR-ratio is 0.90, a repeat MPI is unlikely to yield different results, guiding clinical decision-making. The study highlighted the importance of proper caffeine anamnesis and the potential impact of atrial fibrillation on adenosine response assessment during MPI. Ultimately, the integration of quantitative splenic switch-off assessment may enhance future clinical decision-making in MPI.

Keywords

Myocardial perfusion imaging

PET imaging

Splenetic switch-off

Adenosine response

Parametric blood flow images

Spleen stress/rest-ratio

Repeat MPI

Atrial fibrillation

Caffeine anamnesis

Clinical decision-making