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Myocardial blood flow (MBF) and flow reserve are usually quantified in theclinic with positron emission tomography (PET) using a perfusion-specificradiotracer (e.g. 82Rbchloride). However, the clinical accessibility ofexisting perfusion tracers remains limited. Meanwhile, 18F-fluorodeoxyglucose(FDG) is a commonly used radiotracer for PET metabolic imaging without similarlimitations. In this paper, we explore the potential of 18F-FDG for myocardialperfusion imaging by comparing the myocardial FDG delivery rate K1 with MBF asdetermined by dynamic 82Rb PET in fourteen human subjects with heart disease.Two sets of FDG K1 were derived from one-hour dynamic FDG scans. One was theoriginal FDG K1 estimates and the other was the corresponding K1 values thatwere linearly normalized for blood glucose levels. A generalized Renkin-Cronemodel was used to fit FDG K1 with Rb MBF, which then allowed for a nonlinearextraction fraction correction for converting FDG K1 to MBF. The linearcorrelation between FDG-derived MBF and Rb MBF was moderate (r=0.79) before theglucose normalization and became much improved (r>0.9) after glucosenormalization. The extraction fraction of FDG was also similar to that ofRb-chloride in the myocardium. The results from this pilot study suggest thatdynamic cardiac FDG-PET with tracer kinetic modeling has the potential toprovide MBF in addition to its conventional use for metabolic imaging.

Multiparametric Cardiac 18F-FDG PET: Pilot Comparison of FDG Delivery Rate with 82Rb Myocardial Blood Flow