¹⁸F-Flurpiridaz PET in myocardial perfusion imaging: comparing effectiveness against traditional tracers

Myocardial perfusion imaging (MPI) has served as a cornerstone of coronary artery disease (CAD) evaluation for over four decades, including many other cardiac diseases. MPI is extremely valuable for both diagnostic and prognostic purposes in clinical environments, enabling clinicians to evaluate a patient's coronary health. Perfusion scanning utilizes two primary imaging techniques: single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Each relies on radioactive tracers, which are radioactive substances injected into a patient that spread across myocardial tissue and emit photons or positrons detectable by cameras. Traditional radiotracers include ¹⁵O-water, ¹³N-ammonia, and ⁸²Rb-chloride for PET and ^99mTc-sestamibi for SPECT, which vary in physical and biological properties, including half-life and extraction fraction, influencing image quality, workflow, and clinical utility. Recently, a new PET radiotracer called ¹⁸F-Flurpiridaz has shown promise for increased efficiency among traditional radiotracers, such as a substantially longer half-life. Additional advantages of this radiotracer include, but are not limited to, improved cost-effectiveness due to the use of a pre-existing delivery system, superior image quality, mid-exercise testing, and solving "imaging deserts", which are regions with a lack of medical imaging services that rural areas face. We aim to review the advantages and disadvantages of ¹⁸F-Flurpiridaz PET and compare its effectiveness against traditional PET and SPECT tracers in this article.