Effect of PET-CT misalignment on the quantitative accuracy of cardiac (15)O-water PET

BACKGROUND: Quantification of myocardial blood flow (MBF) with PET requires accurate attenuation correction, which is performed using a separate CT. Misalignment between PET and CT scans has been reported to be a common problem. The purpose of the present study was to assess the effect of PET CT misalignment on the quantitative accuracy of cardiac (15)O-water PET. METHODS: Ten clinical patients referred for evaluation of ischemia and assessment of MBF with (15)O-water were included in the study. Eleven different misalignments between PET and CT were induced in 6 different directions with 10 and 20 mm amplitudes: caudal (+Z), cranial (− Z), lateral (±X), anterior (+Y), and anterior combined with cranial (+ Y and − Z). Blood flow was quantified from rates of washout (MBF) and uptake (transmural MBF, MBFt) for the whole left ventricle and the three coronary territories. The results from all misalignments were compared to the original scan without misalignment. RESULTS: MBF was only minorly affected by misalignments, but larger effects were seen in MBFt. On the global level, average absolute deviation across all misalignments for MBF was 1.7% ± 1.4% and for MBFt 5.4% ± 3.2 Largest deviation for MBF was − 4.8% ± 5.8% (LCX, X + 20) and for MBFt − 19.3% ± 9.6% (LCX, X + 20). In general, larger effects were seen in LAD and LCX compared to in RCA. CONCLUSION: The quantitative accuracy of MBF from (15)O-water PET, based on the washout of the tracer, is only to a minor extent affected by misalignment between PET and CT. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-020-02408-6) contains supplementary material, which is available to authorized users.