Innovative PET Imaging Technique Enhances Detection of Coronary Artery Disease

A novel cardiac PET imaging method has been developed to improve the detection of significant coronary artery disease (CAD), offering a simplified protocol that maintains high diagnostic accuracy. This advanced approach reduces the complexity typically associated with traditional imaging protocols, making it more accessible for clinical use, especially during exercise stress testing.

The study, published in the Journal of Nuclear Medicine and presented at the SNMMI 2025 Annual Meeting, highlights the use of the imaging agent 18F-flurpiridaz. Approved recently by the FDA, this agent enables doctors to assess blood flow to the heart in patients with suspected or known cardiac issues. Its longer activity in the body allows for effective imaging after exercise, providing valuable insights into how the heart performs under stress.

A key limitation of conventional PET imaging with 18F-flurpiridaz has been the difficulty in performing first-pass kinetic modeling post-exercise, which is crucial for quantifying myocardial flow reserve (MFR). To address this, researchers evaluated whether static post-stress images could reliably estimate MFR during both pharmacologic and treadmill exercise stress.

Involving 220 patients with coronary artery disease, the study conducted PET scans at rest and after stress induced either by medication or treadmill exercise. The team measured myocardial blood flow and standardized uptake values (SUV) and developed a mathematical model linking SUV ratios to blood flow ratios. This model accurately estimated MFR, showing strong agreement with invasive coronary angiography results.

The findings suggest that this simplified PET approach can accurately detect multivessel coronary artery disease during exercise and pharmacologic stress, potentially positioning treadmill exercise PET as a first-line diagnostic tool. This method's ease of implementation could facilitate widespread adoption by PET/CT vendors and cardiac analysis software providers.

Overall, this breakthrough could enhance heart disease diagnosis and risk stratification, making cardiac imaging more efficient, especially during exercise testing, which reflects real-world cardiac function under stress.

For further details, refer to the article "Quantification of Myocardial Flow Reserve using Exercise Stress F-18-Flurpiridaz PET Imaging" in the Journal of Nuclear Medicine.