Emerging F-18-Labelled PET Myocardial Perfusion Tracers
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NUCLEAR CARDIOLOGY (V DILSIZIAN, SECTION EDITOR)
Emerging F-18-Labelled PET Myocardial Perfusion Tracers Riccardo Liga 1 & Danilo Neglia 2,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review PET myocardial perfusion imaging (MPI) is an established modality for the evaluation of ischemic heart disease and quantitation of myocardial blood flow (MBF). New F-18-labelled radiopharmaceuticals have been recently developed to overcome some of the limitations of currently used tracers such as the need of an on-site cyclotron. The characteristics of the new tracers and the clinical results obtained so far will be reviewed. Recent Findings Most of the interest in the field of 18F-labelled radiotracers for PET MPI has been concentrated on MC-1 inhibitors, the prototype of which is 18F-flurpiridaz. It was shown in experimental and clinical reports that these radiotracers allow good quality rest/stress MPI studies and a reliable quantitation of MBF. Summary Recent evidence suggests that PET MPI with 18F-flurpiridaz may provide a superior diagnostic accuracy for obstructive CAD even if a large comparative clinical trial with SPECT is still ongoing. Keywords Positron emission tomography . Myocardial perfusion imaging . Myocardial blood flow . Coronary artery disease
Introduction Currently, single-photon emission computed tomography (SPECT) still represents the mainstay for myocardial perfusion imaging (MPI), with historical data supporting its use for the characterization and risk stratification of patients with suspected or known ischemic heart disease (IHD) [1]. However, more recent appraisals have shown a suboptimal accuracy of this technique for the detection of hemodynamically significant CAD, particularly in patients with a low prevalence of disease [2, 3]. Moreover, several technical factors limit the accuracy of this test, such as suboptimal radiotracers’ characteristics, low spatial resolution and infrequent use of This article is part of the Topical Collection on Nuclear Cardiology * Danilo Neglia [email protected] Riccardo Liga [email protected]; [email protected] 1
Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
2
Cardiovascular Department, Fondazione CNR Regione Toscana G. Monasterio, Via G Moruzzi 1, 56124 Pisa, Italy
3
Sant’Anna School of Advanced Studies, Pisa, Italy
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F-labelled radiotracers . Cardiac imaging .
attenuation correction. In this context, positron emission tomography (PET) may provide significant advantages over SPECT MPI, because of intrinsically higher spatial and temporal resolution, as well as higher count sensitivity [4, 5]. Moreover, the wide availability of hybrid scanners equipped with computed tomography (CT) allows reliable attenuation correction of the source data, as well as combined anatomicfunctional imaging [6, 7]. Finally, the short half-life of available perfusion PET radiotracers allows expedite stress/rest imaging sessions, while the superior radiotracer kinetics has led t
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