Ammonia N-13
A radioactive form of ammonia gas, made fresh on site in a cyclotron and injected into a vein; heart muscle cells trap it in proportion to how much blood is flowing through, so a PET scan maps blood flow to the heart very precisely.
Overview
Ammonia N-13 injection is a cyclotron-produced PET myocardial perfusion agent, initial US approval 2007 (NDA 22-119, full approval 2011), taken up and metabolically trapped in myocytes as N-13 glutamine, giving image quality and quantitative accuracy that ASNC/SNMMI guidelines rate among the best of the FDA-approved and CMS-reimbursable PET perfusion tracers (the others being Rb-82; O-15 water is used in Europe but is not FDA approved).
The FDA label indicates it for diagnostic PET imaging of the myocardium under rest or pharmacologic stress to evaluate myocardial perfusion in patients with suspected or existing coronary artery disease. The recommended adult dose is 10-20 mCi (0.368-0.736 GBq) as an intravenous bolus for each of the rest and stress studies, with the stress study begun 40 minutes or more after the first injection to allow adequate decay of the 9.97-minute isotope; imaging starts about 3 minutes after injection.
Because it requires an on-site or very nearby cyclotron (unlike generator-based Rb-82), N-13 ammonia's use is concentrated at academic and large hospital PET centres; it is the other guideline-endorsed option, alongside Rb-82, for the resting perfusion half of the two-part cardiac sarcoidosis PET protocol, and is favoured by some centres for absolute myocardial blood flow quantification given its longer half-life relative to Rb-82, which allows more complete kinetic sampling.
1.Ammonia N-13 slips into a pocket on its target.
- Route
- Intravenous bolus injection
- Schedule
- 10-20 mCi (0.368-0.736 GBq) per rest or stress study; imaging begins about 3 minutes after injection for 10-20 minutes; stress study begun 40+ minutes after the rest dose
Source: www.accessdata.fda.gov/drugsatfda_docs/label/2011/022119s001lbl.pdf. Doses are for orientation; the current label governs.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2007 | Diagnostic PET imaging of the myocardium under rest or pharmacologic stress to evaluate myocardial perfusion in patients with suspected or existing coronary artery disease |
Trials
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Latest papers
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