Cardiac PET perfusion tracers: current status and future directions

Area of Science:

• Nuclear Medicine
• Cardiovascular Imaging
• Radiochemistry

Background:

• Positron Emission Tomography Myocardial Perfusion Imaging (PET MPI) is vital for noninvasive coronary artery disease evaluation.
• Current PET MPI tracers (e.g., (82)Rb, (15)O water, (13)N ammonia) have limitations including short half-lives, cyclotron dependence, and suboptimal image resolution.
• These limitations restrict their use with treadmill exercise stress testing and affect diagnostic accuracy.

Purpose of the Study:

• To evaluate the potential of novel (18)F-labeled PET perfusion tracers for improved PET MPI.
• To highlight Flurpiridaz F 18 as a promising (18)F-based radiotracer for clinical evaluation.
• To assess the characteristics of ideal PET MPI radiotracers.

Main Methods:

• Review of preclinical and clinical data for (18)F-labeled PET perfusion tracers.
• Comparison of properties of (18)F tracers with existing PET MPI agents.
• Evaluation of Flurpiridaz F 18's performance in animal models and early clinical studies.

Main Results:

• (18)F-labeled tracers offer a longer half-life (109 minutes) enabling unit-dose availability and compatibility with treadmill exercise.
• The short positron range of (18)F improves image and defect resolution compared to agents like (82)Rb.
• Flurpiridaz F 18 demonstrated high myocardial extraction, uptake, and contrast, with slow clearance and excellent resolution in preclinical and clinical settings.

Conclusions:

• (18)F-labeled PET perfusion tracers, particularly Flurpiridaz F 18, represent a significant advancement over current agents for PET MPI.
• These tracers overcome key limitations, offering improved diagnostic capabilities for coronary artery disease.
• Flurpiridaz F 18 exhibits ideal properties for PET MPI, warranting further clinical investigation.