Exponential dosing to standardize myocardial perfusion image quality with rubidium-82 PET

BACKGROUND: (82)Rb PET is commonly performed using the same injected activity in all patients, resulting in lower image quality in larger patients. This study compared (82)Rb dosing with exponential vs proportional functions of body weight on the standardization of myocardial perfusion image (MPI) quality. METHODS: Two sequential cohorts of N = 60 patients were matched by patient weight. Rest and dipyridamole stress (82)Rb PET was performed using 0.1 MBq·kg(−2) exponential and 9 MBq·kg(−1) proportional dosing. MPI scans were compared qualitatively with visual image quality scoring (IQS) and quantitatively using the myocardium-to-blood contrast-to-noise ratio (CNR) and blood background signal-to-noise ratio (SNR) as a function of body weight. RESULTS: Average (min–max) patient body weight was 81 ± 18 kg (46–137 kg). Proportional dosing resulted in decreasing CNR, SNR, and visual IQS with increasing body weight (P < 0.05). Exponential dosing eliminated the weight-dependent decreases in these image quality metrics that were observed in the proportional dosing group. CONCLUSION: (82)Rb PET dosing as an exponential (squared) function of body weight produced consistent stress perfusion image quality over a wide range of patient weights. Dramatically lower doses can be used in lighter patients, with the equivalent population dose shifted toward the heavier patients to standardize diagnostic image quality. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12350-023-03303-6.