The next step in improving (semi-)quantitative MPI PET

BACKGROUNDMyocardial blood flow (MBF) quantification with PET results in an improved risk assessment of coronary artery disease (CAD) in addition to semi-quantitative myocardial perfusion imaging. 1 A decrease in the myocardial flow reserve (MFR, MBF in stress/MBF in rest) or an increasing area of perfusion deficits results in a higher risk on cardiac mortality, as shown in Figure 1.To be able to quantify MBF, tracer uptake in the left ventricle and the myocardium during the scan has to be calculated from the imaging data.However, in the process of data acquisition, reconstruction, post-processing and interpretation of the data, there are several pitfalls that one should be aware of as these pitfalls can result in unreliable uptake calculations and hence MBF measurements. 2ultiple pitfalls for MBF quantification and corresponding solutions have been identified in the last decade.First, it is important that the PET scanner has a sufficient count-rate capability to prevent detector saturation during the first-pass phase which can lead to artificially high MBF values. 3,4Secondly, to increase the reproducibility of MBF measurements, a constant activity infusion profile is required. 5Yet not all Strontium-82-Rubidium-82 generators are able to produce such a constant activity bolus.Third, misregistration of PET