RT Book, Section A1 Bateman, Timothy M. A2 Heller, Gary V. A2 Bateman, Timothy M. A2 Case, James A. A2 Arumugam, Parthiban SR Print(0) ID 1159184828 T1 Quantitative Myocardial Blood Flow: Practical Clinical Perspective with Case Examples T2 Cardiovascular PET: Current Concepts YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259860485 LK accesscardiology.mhmedical.com/content.aspx?aid=1159184828 RD 2024/03/29 AB Measurement of blood flow to the myocardium represents a quantum leap forward for the field of nuclear cardiology. Quantification of myocardial blood flow as a routine part of rest/stress myocardial perfusion imaging is a unique attribute of cardiac PET. Although the quantification is actually measured in mL/min/g of myocardium, it is usually expressed as a ratio between peak hyperemia and rest. This ratio is termed myocardial blood flow reserve (MBFR) or coronary flow reserve (CFR). In this chapter we use the term MBFR to be in agreement with a recently published joint position paper of the American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI).1 MBFR can be measured on a pixel-by-pixel basis if there are sufficient counts, but for clinical applications MBFR is reported globally (an average for the entire myocardium), segmentally, or by coronary territory. Some patients have high resting flows that can artifactually lower MBFR; therefore, it is important to also consider peak hyperemic myocardial blood flow (MBF) in some cases, especially in patients with low MBFR and high resting MBF. There has not been a consensus as to whether peak hyperemic MBF or MBFR is superior for assessing epicardial and microvascular health.2,3 A recent study examined cardiovascular mortality in more than 4000 consecutive patients, and found that MBFR was a stronger predictor of outcomes than peak flow.4 In keeping with many studies in the literature, in this chapter we focus primarily on MBFR.