Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2026
Transient ischemic dilation with 18F-flurpiridaz positron emission tomography: Establishing thresholds for a novel radiotracer.
СтатьяМногоцентровое исследованиеКлиническое исследование III фазыНазвание и аннотация: Перевод в очереди
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Letourneau-Shesaf Sevan, Chen Yimin, Lemley Mark, Ramirez Giselle, Kavanagh Paul, Shanbhag Aakash, Liang Joanna X, Buckley Christopher, Miller Robert J H, Berman Daniel S, Slomka Piotr
Аннотация
BACKGROUND: Transient ischemic dilation (TID) of the left ventricule (LV) is a specific marker of extensive coronary artery disease (CAD). Normal limits for TID using 18F-flurpiridaz have not been established.
METHODS: We performed a secondary analysis of the multicenter phase III flurpiridaz-301 trial, which included patients with suspected CAD who underwent rest-stress 18F-flurpiridaz positron emission tomography (PET), Tc-99m single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and invasive coronary angiography (ICA). TID was calculated using ungated left ventricular volumes. Stress-specific reference thresholds were derived in patients without angiographic CAD. The effects of stress modality, CAD severity, and postreconstruction Gaussian filtering on TID measurements were evaluated.
RESULTS: Among 746 patients with evaluable PET, SPECT, and angiographic data, stress-specific TID reference thresholds (97.5th percentile) for 18F-flurpiridaz PET using a 5-mm Gaussian filter were 1.18 for exercise stress and 1.25 for pharmacologic stress. Corresponding Tc-99m SPECT thresholds were lower. PET-derived TID values increased progressively with angiographically defined CAD severity, demonstrating a graded association across disease categories. Application of post-reconstruction Gaussian filtering resulted in lower PET-derived TID values compared with unfiltered images, with modest differences between 5-mm and 8-mm filters.
CONCLUSIONS: This study suggests stress-specific reference thresholds for TID using 18F-flurpiridaz PET in a large multicenter cohort. PET-derived TID values were higher than those observed with Tc-99m SPECT, varied by stress modality, and were influenced by postreconstruction filtering. These findings highlight the importance of tracer-, stress-, and protocol-specific reference standards for accurate clinical interpretation of TID.
METHODS: We performed a secondary analysis of the multicenter phase III flurpiridaz-301 trial, which included patients with suspected CAD who underwent rest-stress 18F-flurpiridaz positron emission tomography (PET), Tc-99m single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and invasive coronary angiography (ICA). TID was calculated using ungated left ventricular volumes. Stress-specific reference thresholds were derived in patients without angiographic CAD. The effects of stress modality, CAD severity, and postreconstruction Gaussian filtering on TID measurements were evaluated.
RESULTS: Among 746 patients with evaluable PET, SPECT, and angiographic data, stress-specific TID reference thresholds (97.5th percentile) for 18F-flurpiridaz PET using a 5-mm Gaussian filter were 1.18 for exercise stress and 1.25 for pharmacologic stress. Corresponding Tc-99m SPECT thresholds were lower. PET-derived TID values increased progressively with angiographically defined CAD severity, demonstrating a graded association across disease categories. Application of post-reconstruction Gaussian filtering resulted in lower PET-derived TID values compared with unfiltered images, with modest differences between 5-mm and 8-mm filters.
CONCLUSIONS: This study suggests stress-specific reference thresholds for TID using 18F-flurpiridaz PET in a large multicenter cohort. PET-derived TID values were higher than those observed with Tc-99m SPECT, varied by stress modality, and were influenced by postreconstruction filtering. These findings highlight the importance of tracer-, stress-, and protocol-specific reference standards for accurate clinical interpretation of TID.