pitfalls in quantitative myocardial pet perfusion i: myocardial partial volume correction

Pet quantitative myocardial perfusion requires correction for partial volume loss due to one-dimensional lv wall thickness smaller than scanner resolution. we aimed to assess accuracy of risk stratification for death, mi, or revascularization after pet using partial volume corrections derived from two-dimensional acr and three-dimensional nema phantoms for 3987 diagnostic rest–stress perfusion pets and 187 mace events. nema, acr, and tree phantoms were imaged with rb-82 or f-18 for size-dependent partial volume loss. perfusion and coronary flow capacity were recalculated using different acr- and nema-derived partial volume corrections compared by kolmogorov–smirnov statistics to standard perfusion metrics with established correlations with mace. partial volume corrections based on two-dimensional acr rods (two equal radii) and three-dimensional nema spheres (three equal radii) over estimate partial volume corrections, quantitative perfusion, and coronary flow capacity by 50% to 150% over perfusion metrics with one-dimensional partial volume correction, thereby substantially impairing correct risk stratification. acr (2-dimensional) and nema (3-dimensional) phantoms overestimate partial volume corrections for 1-dimensional lv wall thickness and myocardial perfusion that are corrected with a simple equation that correlates with mace for optimal risk stratification applicable to most pet-ct scanners for quantifying myocardial perfusion.