New international guideline provides expert guidance for PET imaging of patients with coronary artery disease

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) have issued a new clinical guideline for ¹⁸F-flurpiridaz PET myocardial perfusion imaging (MPI) and blood flow quantitation. The guideline, co-published in the Journal of Nuclear Medicine and the Journal of Nuclear Cardiology, is intended to assist nuclear cardiology practitioners in the optimal application of ¹⁸F-flurpiridaz PET for MPI, including recommendations for patient selection, imaging protocols, and interpretation of results.

Coronary artery disease (CAD) is the leading cause of death worldwide and is responsible for the hospitalization, functional decline, and reduced quality of life for millions of patients each year. Early and accurate diagnosis and risk stratification of CAD are essential for guiding treatment and improving patient outcomes. MPI is a cornerstone of noninvasive assessment of myocardial ischemia.

MPI can be performed with SPECT or PET. ¹⁸F-flurpiridaz is a novel PET radiotracer that has demonstrated favorable imaging and physiological properties compared to conventional SPECT agents. Clinical studies have shown that it provides superior image quality, improved diagnostic accuracy, and greater sensitivity in detecting clinically significant coronary artery stenosis compared with conventional SPECT agents. It is particularly valuable in patients for whom SPECT may be less effective, such as those with obesity or small left ventricles.

"Multiple phase II and two phase III clinical trials have further established the utility of ¹⁸F-flurpiridaz as a valuable PET radiotracer for the noninvasive evaluation of CAD," noted René R. Sevag Packard, MD, Ph.D. "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 guideline includes information on clinical indications, contraindications, and considerations for ¹⁸F-flurpiridaz PET. It addresses qualifications and responsibilities of personnel performing cardiac stress testing using ¹⁸F-flurpiridaz, protocol (and potential protocol modifications), biodistribution and dosimetry, and the ¹⁸F-flurpiridaz PET workflow. Technologist considerations are also included.

"This document is designed to promote high-quality, safe, and effective nuclear medicine practice in the evaluation of CAD," emphasized the authors. "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."

SNMMI, ASNC, EANM, and ACNM periodically define new procedure standards/practice guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to deliver effective and safe medical care to patients. Each standard/guideline, representing a policy statement by these groups, undergoes a thorough consensus process in which it is subjected to extensive review.

More information:
SNMMI/EANM/ASNC/ACNM Procedure Standard/Practice Guideline for ¹⁸F-Flurpiridaz PET Myocardial Perfusion Imaging and Blood Flow Quantitation, Journal of Nuclear Medicine (2025). DOI: 10.2967/jnumed.125.270873, jnm.snmjournals.org/content/ea … 18/jnumed.125.270873

Provided by Society of Nuclear Medicine and Molecular Imaging