N-13 Ammonia paves the way to better diagnostics with a low positron range, excellent extraction and retention, high sensitivity and overall accuracy for detecting CAD.1 The result is better risk classification and overall patient management.
Providing high diagnostic accuracy in all patient types, N-13 Ammonia is used in a growing number of major academic institutions and is rapidly changing the standard of excellence for Cardiac PET imaging.
1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382649/
Superior Image Quality1
While Cardiac PET has been shown to be superior to SPECT, not all tracers are equal. Considered an optimal tracer for myocardial perfusion imaging, N-13 Ammonia provides:
- High spatial and contrast resolution images
- High first-pass extraction and retention in the myocardium
- Consistently high-quality diagnostic studies regardless of patient size or gender
1. Fiechter et al., J Nucl Med 2012; 53: 1230-1234
Expanded Testing Options
Due to a longer half-life, N-13 Ammonia may allow for testing options not possible with other FDA-approved tracers.
Recent studies utilizing treadmill N-13 Ammonia stress testing have demonstrated:
- Reliable diagnostic accuracy and image quality in obese and non-obese patients1
- Annual event rate consistent with previously published SPECT and PET data2
- Produces larger, more severe defects compared to dipyridamole stress3
- Aggarwal NR, Drozdova A, Askew JW, Kemp BJ, Chareonthaitawee P. Feasibility and diagnostic accuracy of exercise treadmill nitrogen-N-13 Ammonia PET myocardial perfusion imaging of obese patients. Journal of Nuclear Cardiology. 2015 Dec 1;22(6):1273-80.
- Chow BJ, Al Shammeri OM, Beanlands RS, Chen L, DaSilva J, Ruddy TD. Prognostic value of treadmill exercise and dobutamine stress positron emission tomography. Canadian Journal of Cardiology. 2009 Jul 1;25(7):e220-4.
- Chow BJ, Beanlands RS, Lee A, DaSilva JN, Alkahtani A, Ruddy TD. Treadmill exercise produces larger perfusion defects than dipyridamole stress N-13 ammonia positron emission tomography. Journal of the American College of Cardiology. 2006 Jan 17;47(2):411-6.
N-13 Ammonia v. Rb-82 Chloride
N-13 Ammonia v. Rb-82 Chloride Comparison
| Physical properties 2 | N-13 Ammonia | Rb-82 Chloride |
|---|---|---|
| Half life (min) | 9.97 | 1.27 |
| Positron decay | 100% | 95.5% |
| Positron range (mm) | 0.57 | 2.60 |
| Image Resolution (mm) FWHM | 5 | 8 |
| Effective radiation (mSv/MBq) | 0.002 | 0.0034 |
| Raw material | High Purity O-16 water and methane gas | Sr-82/Sr-85 |
| Supplied | Unit Dose | Generator |
| Physiological properties 1 | N-13 Ammonia | Rb-82 Chloride |
|---|---|---|
| Physiology | Diffusible/retained | Extracted/retained |
| Rest | Stress | Rest | Stress | |
|---|---|---|---|---|
| Extraction fraction | 0.98 | 0.93 | 0.70 | 0.40 |
| Retention fraction | 0.87-0.97 | 0.56-0.65 | 0.47-0.55 | 0.27-0.28 |
- deKemp et. al. “Will 3-dimensional PET-CT enable the routine quantification of myocardial blood flow?” J. Nucl Cardiol 2007; 14:380-97
- Sabin, MG, Radiopharmaceuticals for Nuclear Cardiology: Radiation Dosimetry, Uncertainties, and Risk, J Nucl Med 2008; 49:1555-1563
Reimbursement
Reimbursement is critical to the financial viability of any Cardiac PET program. N-13 Ammonia is FDA-approved and reimbursed by Medicare and most private payers. Plus, IONETIX stands ready to help you navigate the reimbursement process so you can focus on what you do best: delivering the best care possible.
Prescribing Information
INDICATIONS AND USAGE
N-13 Ammonia Injection is a radioactive diagnostic agent for Positron Emission Tomography (PET) indicated for diagnostic PET imaging of the myocardium under rest or pharmacologic stress conditions to evaluate myocardial perfusion in patients with suspected or existing coronary artery disease.
CONTRAINDICATIONS
None known.
ADVERSE REACTIONS
No adverse reactions have been reported for N-13 Ammonia Injection based on a review of the published literature, publicly available reference sources, and adverse drug reaction reporting system.
WARNINGS AND PRECAUTIONS
N-13 Ammonia Injection may increase the risk of cancer. Use the smallest dose necessary for imaging and ensure safe handling to protect the patient and health care worker.