Comparative Evaluation of [18F]FMPP and [13N]Ammonia PET Myocardial Perfusion Imaging in Coronary Artery Disease: A Prospective Analysis of Image Quality and Diagnostic Performance

Introduction: Aims: This study aimed to evaluate image quality, diagnostic performance, myocardial perfusion and left ventricular function of [¹⁸F]FMPP (FMPP) PET myocardial perfusion imaging (MPI) compared with [¹³N]Ammonia (NH₃) PET MPI.Aims: This study aimed to evaluate image quality, diagnostic performance, myocardial perfusion and left ventricular function of [¹⁸F]FMPP (FMPP) PET myocardial perfusion imaging (MPI) compared with [¹³N]Ammonia (NH₃) PET MPI.

Methods: Forty-seven patients with suspected or known coronary artery disease (CAD) were prospectively enrolled to undergo one-day rest/ATP-stress FMPP and NH₃ electrocardiograph-gated PET imaging within 2 weeks. Among them, twenty-six patients underwent invasive coronary angiography (ICA), and eighteen were identified with flow-limited CAD (stenosis≥70%). Image quality (excellent/good/average) was evaluated by two independent, blinded readers.

Results: Linear regression of rest/stress myocardial perfusion in 17 segments revealed the linear slope close to unity with excellent R² value (rest: slope=0.954-1.074, R²=0.990-0.997; stress: slope=0.951-1.082, R²=0.971-0.996). Despite a higher liver uptake, FMPP demonstrated excellent to good image quality (83%) comparable to NH3 (95.7%, p = 0.091). The Summed Rest Score (SRS), Summed Stress Score (SSS) and Summed Difference Score (SDS) for FMPP and NH₃ PET were not significantly different (all P≥0.248). Despite a higher liver uptake, FMPP demonstrated excellent to good image quality (83%) comparable to NH₃ (95.7%, P=0.091). The sensitivity and specificity levels of FMPP and NH₃ MPI were similar (78.0% vs. 78.0%, 100% vs. 88%, P=1.00).

Conclusions: FMPP PET MPI demonstrates a promise in achieving good image quality with the diagnostic performance similar to NH₃ PET MPI. Future research should concentrate on the quantitative analysis of myocardial blood flow to explore the clinical implications of FMPP PET MPI in diagnosing CAD.