PT - JOURNAL ARTICLE AU - Zhang, Feifei AU - Yang, Xiaoyu AU - Shao, Xiaoliang AU - Wang, Jianfeng AU - Wang, Yuetao TI - <strong>Advantages of rest 18F-FDG myocardial imaging over rest 99mTc-MIBI myocardial perfusion imaging in the diagnosis of obstructive coronary artery disease in Chinese patients with suspected acute coronary syndrome: a prospective real-world clinical study</strong> DP - 2022 Aug 01 TA - Journal of Nuclear Medicine PG - 3377--3377 VI - 63 IP - supplement 2 4099 - http://jnm.snmjournals.org/content/63/supplement_2/3377.short 4100 - http://jnm.snmjournals.org/content/63/supplement_2/3377.full SO - J Nucl Med2022 Aug 01; 63 AB - 3377 Introduction: Rest myocardial perfusion imaging (MPI) is helpful in the diagnosis of suspected acute coronary syndrome (ACS), but the sensitivity is low. The purpose of this study is to investigate the clinical application value and diagnostic efficacy of rest 18F-deoxyglucose (18F-FDG) myocardial imaging alone in Chinese patients with chest pain and suspected ACS and compared it with rest MPI. Methods: One hundred and thirty-one patients with chest pain symptoms and clinical suspicion of ACS were prospectively included. All patients underwent rest 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography (SPECT) MPI and 18F-FDG positron emission tomography (PET) myocardial imaging on the same day and underwent invasive coronary arteriography (ICA) within 1 week after imaging. Obstructive coronary artery disease (CAD) was defined as ≥ 50% stenosis of left main stem and ≥ 70% stenosis in left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). High-grade coronary stenosis was defined as stenosis of any of the above vessels and their main branches ≥ 90%. With ICA results as the reference standard, the efficacy of rest 18F-FDG myocardial imaging alone in the diagnosis of obstructive CAD was estimated at both the patient level and the vascular level and was compared with that of rest MPI. Results: Obstructive CAD was diagnosed in 68 of 131 patients with chest pain and suspected ACS (51.9%), and stenosis ≥70% was confirmed in 125 vascular territories (31.8%). At the patient level, rest 18F-FDG myocardial imaging had a better diagnostic specificity (92.1% vs. 71.4%, P=0.005), positive predictive value (PPV: 89.1% vs. 66.1%, P=0.008), and accuracy (75.6% vs. 61.1%, P=0.017) than rest MPI in terms of diagnosing obstructive CAD. It had a greater area under the receiver operating characteristic curve (AUC, 0.762 vs. 0.614, P&lt;0.001) and a positive net reclassification index (NRI) (0.2946, P&lt;0.001). There was no significant difference in sensitivity or negative predictive value (NPV), though both were higher for rest 18F-FDG imaging (60.3% vs. 51.5%, P=0.388; 68.2% vs. 57.7%, P=0.194). At the vascular level, compared with rest MPI for the diagnosis of obstructive coronary artery stenosis, rest 18F-FDG myocardial imaging showed greater diagnostic sensitivity (46.4% vs. 29.6%, P=0.009), specificity (94.0% vs. 88.4%, P=0.032), PPV (78.4% vs. 54.4%, P=0.004), and accuracy (78.9% vs. 69.7%, P=0.004), and its NPV tended to be higher (79.0% vs. 72.9%, P=0.080). Its AUC was greater (0.702 vs. 0.590, P&lt;0.0001), and it had a positive NRI (0.2240, P&lt;0.0001). Of the 393 vascular territories in the 131 included patients with chest pain and suspected ACS, high-grade coronary stenosis was observed in 71 (18.1%). In the diagnosis of high-grade coronary artery stenosis, rest 18F-FDG myocardial imaging was significantly better than rest MPI in diagnostic sensitivity (60.6% vs. 32.4%, P=0.001), PPV (58.1% vs. 33.8%, P=0.004), NPV (91.2% vs. 85.2%, P=0.020), and accuracy (85.0% vs. 76.3%, P=0.003), it tended to be better in specificity (90.4% vs. 86.0%, P=0.112). The AUC of rest 18F-FDG myocardial imaging was greater (0.755 vs. 0.592, P&lt;0.0001), and its NRI was positive (0.3252, P&lt;0.0001).Conclusions: Compared with rest MPI, rest 18F-FDG myocardial imaging alone improved the overall diagnostic efficacy for obstructive CAD in Chinese patients with chest pain and suspected ACS at both the patient and vascular levels. In particular, the improvement in efficacy was more pronounced for the diagnosis of high-grade coronary artery stenosis.