The introduction of the new F-18 flurpiridaz (Flyrcado) PET cardiovascular perfusion tracer was met with a large amount of enthusiasm due to the fact that it will help facilitate wider expansion of cardiac PET. But the new radiotracer has different imaging characteristics from the long-available PET rubidium-82 generators, so new guidelines for flurpiridaz were released this week by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), American Society of Nuclear Cardiology (ASNC), European Association of Nuclear Medicine (EANM) and American College of Nuclear Medicine (ACNM).[1]
The new clinical guideline outlines the use of F-18 flurpiridaz for PET myocardial perfusion imaging (MPI) and blood flow quantitation. It was co-published in both the Journal of Nuclear Medicine and the Journal of Nuclear Cardiology. The societies said this document is intended to assist nuclear cardiology practitioners in the optimal application of flurpiridaz PET for MPI, including recommendations for patient selection, imaging protocols and the interpretation of results.
The new guidance also includes information on clinical indications, contraindications and other considerations. It addresses qualifications and responsibilities of personnel performing cardiac stress testing using flurpiridaz, biodistribution and dosimetry, and the flurpiridaz PET workflow.
“This document is designed to promote high-quality, safe, and effective nuclear medicine practice in the evaluation of CAD,” the guideline’s authors emphasized. “Our hope is that the guideline enhances clinical decision-making, standardizes clinical practice, improves diagnostic accuracy and optimizes resource utilization to ensure safety and improve patient outcomes.”
“Multiple phase II and two phase III clinical trials have further established the utility of 18F-flurpiridaz as a valuable PET radiotracer for the non-invasive evaluation of CAD,” lead author René R. Sevag Packard, MD, PhD, associate professor-in-residence in the division of cardiology at UCLA’s David Geffen School of Medicine and president elect of the SNMMI Cardiovascular Council, said in a statement. “Owing to its favorable molecular imaging characteristics and extended half-life, 18F-flurpiridaz is poised to become a valuable agent for cardiac stress PET imaging, offering clinicians a robust tool for the evaluation of CAD.”
The PET vs. SPECT debate goes on
MPI can be performed with SPECT or PET nuclear imaging systems, but nuclear cardiology is increasing moving toward PET because of improved image quality as labs update their cameras. Flurpiridaz is a novel PET radiotracer that has demonstrated favorable imaging and physiological properties compared to conventional SPECT agents. Clinical studies showed it provides superior image quality, improved diagnostic accuracy and greater sensitivity in detecting clinically significant coronary artery stenosis compared with SPECT. It is particularly valuable in patients where SPECT may be less effective, such as obese patients and those with small left ventricles.
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