The REgistry of Flow and Perfusion Imaging for Artificial INtelligEnce with PET(REFINE PET): Rationale and Design

Giselle Ramirez¹, Mark Lemley¹, Aakash Shanbhag², Jacek Kwiecinski³, Robert J H Miller⁴, Paul B Kavanagh¹, Joanna X Liang¹, Damini Dey¹, Leandro Slipczuk⁵, Mark I Travin⁶, Erick Alexanderson⁷, Isabel Carvajal-Juarez⁸, René R S Packard⁹, Mouaz Al-Mallah¹⁰, Andrew J Einstein¹¹, Attila Feher¹², Wanda Acampa¹³, Stacey Knight¹⁴, Viet T Le¹⁵, Steve Mason¹⁵, Rupa Sanghani¹⁶, Samuel Wopperer¹⁷, Panithaya Chareonthaitawee¹⁷, Ronny R Buechel¹⁸, Thomas L Rosamond¹⁹, Robert A deKemp²⁰, Daniel S Berman¹, Marcelo F Di Carli²¹, Piotr J Slomka²²

Affiliations

¹ Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
² Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA.
³ Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
⁴ Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
⁵ Cardiology Division, Montefiore Health System/Albert Einstein College of Medicine, NY, USA.
⁶ Department of Radiology (Nuclear Medicine), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
⁷ Department of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
⁸ Department of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico.
⁹ Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA.
¹⁰ Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Academic Institute, Houston, TX, USA.
¹¹ Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, USA.
¹² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
¹³ Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
¹⁴ Intermountain Medical Center Heart Institute, Intermountain Healthcare, Murray, UT, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
¹⁵ Intermountain Medical Center Heart Institute, Intermountain Healthcare, Murray, UT, USA.
¹⁶ Section of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
¹⁷ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁸ Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
¹⁹ Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.
²⁰ Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, ON, Canada.
²¹ Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
²² Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Piotr.Slomka@cshs.org.

PMID: 40774620
DOI: 10.1016/j.nuclcard.2025.102449

The REgistry of Flow and Perfusion Imaging for Artificial INtelligEnce with PET(REFINE PET): Rationale and Design

Giselle Ramirez et al. J Nucl Cardiol. 2025.

. 2025 Aug 5:102449.

doi: 10.1016/j.nuclcard.2025.102449. Online ahead of print.

Authors

Affiliations

¹ Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
² Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Signal and Image Processing Institute, Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA.
³ Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
⁴ Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
⁵ Cardiology Division, Montefiore Health System/Albert Einstein College of Medicine, NY, USA.
⁶ Department of Radiology (Nuclear Medicine), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
⁷ Department of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
⁸ Department of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico.
⁹ Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA.
¹⁰ Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Academic Institute, Houston, TX, USA.
¹¹ Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, USA.
¹² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
¹³ Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
¹⁴ Intermountain Medical Center Heart Institute, Intermountain Healthcare, Murray, UT, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
¹⁵ Intermountain Medical Center Heart Institute, Intermountain Healthcare, Murray, UT, USA.
¹⁶ Section of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
¹⁷ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁸ Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
¹⁹ Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.
²⁰ Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, ON, Canada.
²¹ Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
²² Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Piotr.Slomka@cshs.org.

PMID: 40774620
DOI: 10.1016/j.nuclcard.2025.102449

Abstract

Background: The REgistry of Flow and Perfusion Imaging for Artificial Intelligence with PET (REFINE PET) was established to collect multicenter PET and associated computed tomography (CT) images, together with clinical data and outcomes, into a comprehensive research resource. REFINE PET will enable validation and development of both standard and novel cardiac PET/CT processing methods.

Methods: REFINE PET is a multicenter, international registry that contains both clinical and imaging data. The PET scans were processed using QPET software (Cedars-Sinai Medical Center, Los Angeles, CA), while the CT scans were processed using deep learning (DL) to detect coronary artery calcium (CAC). Patients were followed up for the occurrence of major adverse cardiovascular events (MACE), which include death, myocardial infarction, unstable angina, and late revascularization (>90 days from PET).

Results: The REFINE PET registry currently contains data for 35,588 patients from 14 sites, with additional patient data and sites anticipated. Comprehensive clinical data (including demographics, medical history, and stress test results) were integrated with more than 2200 imaging variables across 42 categories. The registry is poised to address a broad range of clinical questions, supported by correlating invasive angiography (within 6 months of MPI) in 5972 patients and a total of 9252 major adverse cardiovascular events during a median follow-up of 4.2 years.

Conclusion: The REFINE PET registry leverages the integration of clinical, multimodality imaging, and novel quantitative and AI tools to advance the role of PET/CT MPI in diagnosis and risk stratification.

Keywords: PET; artificial intelligence; coronary artery disease; myocardial perfusion imaging; quantitative analysis.

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Conflict of interest statement

Declaration of Competing Interest ☒ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Piotr Slomka reports financial support was provided by National Institutes of Health. Piotr Slomka reports a relationship with APQ Health Inc that includes: equity or stocks. Piotr Slomka reports a relationship with Synektik SA that includes: consulting or advisory. Piotr Slomka reports a relationship with Novo Nordisk that includes: consulting or advisory. RM received consulting fees from Pfizer and research support from Pfizer and Alberta Innovates. DB and PS participated in software royalties for QPS software at Cedars-Sinai Medical Center. DB, DD, and PS reported equity in APQ Health Inc. DB received research grant support from The Dr. Miriam and Sheldon G. Adelson Medical Research Foundation and consulting fees from GE Healthcare. PS received research grant support from Siemens Medical Systems, and consulting fees from Synektik SA and Novo Nordisk. PC reported consulting for Clario. MDC reported consulting fees from MedTrace, Valo Health, GE, Bitterroot Bio, and IBA, investigator-initiated research support from Amgen, and institutional research grant support from Sun Pharma, Xylocor, Alnylam, and Intellia. AJE reported consulting for Artrya, authorship fees from Wolters Kluwer Healthcare—UpToDate and serving on scientific advisory boards for Axcellant and Canon Medical Systems USA; his institution has grants/grants pending from Alexion, Attralus, BridgeBio, Canon Medical Systems USA, GE HealthCare, Intellia Therapeutics, International Atomic Energy Agency, Ionis Pharmaceuticals, National Institutes of Health, Pfizer, and Shockware Medical. RRSP serves as a consultant for GE HealthCare. RS reported being a consultant for GE Healthcare. MA-M received research support from Siemens and GE Healthcare and is a consultant to Jubilant, Medtrace, GE Healthcare, and Pfizer. LS received grant support/consulting honorarium from Amgen and Philips and served as site PI for V-INITIATE and Ocean(a) trials. The remaining authors declare no conflict of interest. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Update of

The REgistry of Flow and Perfusion Imaging for Artificial INtelligEnce with PET (REFINE PET): Rationale and Design.
Ramirez G, Lemley M, Shanbhag A, Kwiecinski J, Miller RJH, Kavanagh PB, Liang JX, Dey D, Slipczuk L, Travin MI, Alexanderson E, Carvajal-Juarez I, Packard RRS, Al-Mallah M, Einstein AJ, Feher A, Acampa W, Knight S, Le VT, Mason S, Sanghani R, Wopperer S, Chareonthaitawee P, Buechel RR, Rosamond TL, deKemp RA, Berman DS, Di Carli MF, Slomka PJ. Ramirez G, et al. medRxiv [Preprint]. 2025 Jul 11:2025.07.10.25330435. doi: 10.1101/2025.07.10.25330435. medRxiv. 2025. Update in: J Nucl Cardiol. 2025 Aug 5:102449. doi: 10.1016/j.nuclcard.2025.102449. PMID: 40672503 Free PMC article. Updated. Preprint.

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The REgistry of Flow and Perfusion Imaging for Artificial INtelligEnce with PET(REFINE PET): Rationale and Design

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The REgistry of Flow and Perfusion Imaging for Artificial INtelligEnce with PET(REFINE PET): Rationale and Design

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