Diagnostic performance of F-flurpiridaz PET myocardial perfusion imaging with total perfusion deficit quantification.

Purpose: To assess the diagnostic performance of F-flupiridaz positron emission tomography (PET) myocardial perfusion imaging (MPI) for coronary artery disease detection using total perfusion deficit (TPD), an automated metric of combined disease extent and severity.

Methods: Flurpiridaz relative perfusion images and quantitative coronary angiography data from the initial phase III trial were evaluated using receiver operating characteristic analysis at separate endpoints of ≥70% stenosis and ≥50% stenosis, to determine the diagnostic performance of TPD at per-patient (global LV) and per-vessel levels. TPD results at both endpoints were compared with the performance of visual scores and defect extent values available from two previous publications.

Results: Using a normal perfusion database that was created with the data of 25 patients from the flurpiridaz trial population, TPD was calculated in the remaining 729 trial patients. At the threshold of ≥70% stenosis, TPD was observed to have similar (P ≥ .05) per-patient diagnostic performance (74% accuracy) to visual scoring from previous publications (75%, 71%), as well as defect extent (72%). At the per-vessel level, the TPD achieved similar performance to defect extent in the left anterior descending artery (LAD) and left circumflex artery (LCx) (79%, 74% vs 80%, 72% accuracy) with slightly higher accuracy in the right coronary artery (RCA) (77% vs 72%, P = .03), and similar performance to visual scoring in the LAD and RCA (77, 79% vs 76%, 76% accuracy) with marginally lower performance in the LCx (74% vs 79%, P = .03). Similar results were observed at the ≥50% obstructive disease endpoint.

Conclusions: Automated TPD demonstrated similar diagnostic performance for global and regional flurpiridaz PET MPI, respectively, to visual scoring and defect extent quantification.