SNM: F18-PET agent performs better than SPECT for detecting CAD

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PET imaging with Lantheus Medical Imaging’s investigational agent flurpiridaz F18 injection (BMS747158) provided better image quality than technetium-99m sestamibi SPECT, for the detection of coronary artery disease, according to phase 2 clinical trial results presented at the SNM annual meeting in Salt Lake City.

Flurpiridaz  F18 is a fluorine 18-labeled agent that binds to mitochondrial complex 1. The data also indicated that PET imaging with flurpiridaz F18 rendered a significantly larger perfusion defect size when compared with the corresponding defects seen in SPECT imaging.

Twenty-six patients (20 men) in a single-center study underwent SPECT and PET imaging within six months without change in clinical state, said Balaji Tamarappoo, MD, clinical fellow at advanced cardiac imaging at Cedars-Sinai Medical Center in Los Angeles.

PET myocardial perfusion imaging was performed with flurpiridaz F18 at rest and was then followed one hour later with imaging at exercise or under pharmacologically-induced (adenosine) stress. The extent and severity of ischemia (summed difference score (SDS)) was derived from the difference between summed stress and summed rest scores.

Findings showed that image quality with flurpiridaz F18 PET was excellent in 24 and good in two patients, in contrast to image quality with SPECT, which was excellent in 17, good in eight and fair in one patient. In 14 patients with abnormal SPECT, the extent and severity of ischemia, mean SDS was greater with PET than with SPECT. In all 12 patients with normal SPECT, SDS was zero by PET and SPECT.

Compared to Tc-99m sestamibi SPECT, flurpiridaz F18 PET provides better image quality and results in a significant increase in the SDS in patients with abnormal SPECT.

“These encouraging preliminary data from our clinical research site show that PET imaging with flurpiridaz F18 injection provided improved image quality and an increase in defect size compared to SPECT,” said Daniel S. Berman, MD, chief, cardiac imaging and nuclear cardiology at Cedars-Sinai. “A PET imaging agent that may provide higher quality images with more obvious perfusion defects can have a profound effect on physicians’ ability to make more definitive assessments of coronary artery disease.”