The REgistry of Flow and Perfusion Imaging for Artificial Intelligence with positron emission tomography (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, Bronx, 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, NY, USA.
¹² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 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, Brigham and Women's Hospital, Boston, MA, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; 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

Multicenter Study

The REgistry of Flow and Perfusion Imaging for Artificial Intelligence with positron emission tomography (REFINE PET):Rationale and design

Giselle Ramirez et al. J Nucl Cardiol. 2025 Oct.

. 2025 Oct:52:102449.

doi: 10.1016/j.nuclcard.2025.102449. Epub 2025 Aug 6.

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, Bronx, 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, NY, USA.
¹² Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 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, Brigham and Women's Hospital, Boston, MA, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; 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 positron emission tomography (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 35595 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 2100 imaging variables across 34 categories. The registry is poised to address a broad range of clinical questions, supported by correlating invasive angiography (within 6 months of PET myocardial perfusion imaging [MPI]) in 5955 patients and a total of 9278 major adverse cardiovascular events during a median follow-up of 4.2 years.

Conclusions: 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: Artificial intelligence; Coronary artery disease; Myocardial perfusion imaging; PET; Quantitative analysis.

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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 Oct;52:102449. 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 positron emission tomography (REFINE PET):Rationale and design

Affiliations

The REgistry of Flow and Perfusion Imaging for Artificial Intelligence with positron emission tomography (REFINE PET):Rationale and design

Authors

Affiliations

Abstract

Update of

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical