Comparative evaluation of a novel [F] F-Labeled PET tracer XTR004 against [N] ammonia in myocardial perfusion imaging for coronary artery disease.

AIMS

This study aimed to evaluate image quality, myocardial perfusion, and diagnostic performance of a novel [F]F-labeled PET tracer, XTR004 PET, myocardial perfusion imaging (MPI) compared with [N]Ammonia (NH) PET MPI.

METHODS AND RESULTS

Forty-seven patients with suspected or known coronary artery disease (CAD) were prospectively enrolled to undergo one-day rest/ATP-stress XTR004 and NH electrocardiograph-gated PET imaging within 2 weeks. Among them, twenty-six patients underwent invasive coronary angiography (ICA), and nineteen were identified with flow-limited CAD (stenosis ≥ 70%). Image quality (excellent/good/average) and certainty of interpretation were evaluated by two independent, blinded readers. Despite a higher liver uptake, XTR004 achieved good to excellent image quality in 83% of cases, comparable to 95.7% of NH(P = 0.091). Additionally, the diagnostic certainty, measured as the percentage of cases with definitely abnormal or normal interpretations, was similar between XTR004 and NH, with results of 87.2% and 89.2%, respectively. The sensitivity and specificity levels of XTR004 and NH MPI were similar (79% vs. 79%, 86% vs. 71%, P = 1.00). Linear regression of rest/stress myocardial perfusion in 17 segments revealed the linear slope close to unity with excellent R value (rest: slope = 0.954-1.074, R = 0.990-0.997; stress: slope = 0.951-1.082, R = 0.971-0.996). XTR004 was tolerated well by all patients. No adverse events were reported.

CONCLUSION

XTR004 PET MPI demonstrated promising image quality, diagnostic certainty and myocardial perfusion characteristics comparable to NH PET MPI. Future research should concentrate on the quantitative analysis of myocardial blood flow to explore the clinical implications of XTR004 PET MPI.