1	Optimization of Fusion PET-CT Imaging Protocol for Combined PET Myocardial Perfusion and CT Coronary Angiography Berger KL¹; Eisenberg J; Benali K²; Bridge W²; Abela GS³ ¹ Department of Radiology, Michigan State University ² General Electric Health Technology ³ Division of Cardiology, Michigan State University American Roentgen Ray Society - May 4, 2004
2	Purpose Explain the technical requirements (equipment and protocols) necessary for optimizing rapid, diagnostic, combined PET myocardial perfusion and CT coronary angiograms.
3
4	Additional Equipment Needs In Vivo Research, Inc. Millenia 3500 CT-P 4 lead ECG B7710ST GE Patient Arm Rest 8500NB GE Case 12 lead ECG Exercise Testing System Pn/E9002rf/Radiotranslucent adapter graber 4mm banna 18” 870-030 Lynn Medical Accusensor Carbone radiotranslucent electrodes Remote ECG monitoring station Boekel Scientific tabletop contrast warmer Harvard Clinical dual infusion pump (optional) Sun Tech Tango automated BP cuff Cardinal Health unit dose tungsten syringe shielding system Crash Cart and Powerheart AED
5
6	CT Coronary Angiography Protocol Visipaque 320 (10 cc timing bolus) and 90 cc contrast bolus at 4 cc/sec with 50 cc saline flush at 4 cc/sec). CT Angio retro reconstruction at 15, 50, 60, 70, 75, 80 phases Snapshot Segment for HR below 60, Snapshot burst for HR below 75. CT Scan acquisition parameters (Cardiac helical, 1.25 mm thickness, 0.275:1 – 0.3:1 pitch, 120 kv, 350 mA, 0.5 rot/sec, SFOV-Large, DFOV-25)
7	PET Processing Parameters FBP Processing Hanning Transaxial Filter 128 x 128 matrix Cutoff 6.5 Diameter 41.9 cm Center L 4.0 cm Measured attenuation Randoms correction by Singles 3D PET Butterworth filtering
8	Patient preparation No caffeine or theophylline 12 hours prior to scan NPO p MN or 4 hours prior to scan Hyperventilate and breath-hold for CT angiography protocol 20G iv preferably in a forearm site Metoprolol 5-10 mg over 2-10’ as necessary for elevated heart rate (>75bpm) 0.568 mg/kg dipyridamole over 4’ 125-150 mg aminophylline
9	MSU Patient Summary 56 Myocardial perfusion PET exams 16 Myocardial perfusion exams combined with CT Angiograms 50% male/female ratio Average age 65.5 years Average weight 199 pounds (120-320)
10	PET/CT Results One patient technical repeat of rest scan secondary to bin acquisition error Diagnostic assessment of wall motion in all patients No change in diagnostic interpretation between background subtracted and non-subtracted images for rest-stress intervals ranging from 25-50 minutes
11	Myocardial Perfusion PET/CT Coronary Angiogram 52 year-old woman with known coronary artery disease. PET/CT exam requested to assess for ischemia and progression of CAD.
12	Myocardial Perfusion PET/CT Coronary Angiography
13
14
15
16
17	Summary Diagnostic, combined PET myocardial perfusion and CT coronary angiogram studies can be performed in less than 1 hour of total time within the scanner. Continued work on background subtraction methodology to improve automation and impact on diagnostic accuracy with larger patient series necessary Extensive equipment needs and personnel training are required to perform these combined exams