1：Experimental Design and Method Selection:

Prospective clinical study comparing 82-Rb-PET-MPS and 99m-Tc-SPECT-MPS in the same patients. Patients underwent both imaging techniques within 90 days. Positive cases were referred for coronary angiography with FFR measurements. A composite endpoint was used for positivity, including significant stenosis on CA or acute coronary events during follow-up.

2：Sample Selection and Data Sources:

313 patients (46% women, mean BMI

3：8) with intermediate prevalence of CAD were recruited from two centers in France. Inclusion criteria:

referred for SPECT-MPS, adult women or men with BMI ≥ 25, intermediate CAD prevalence. Exclusion criteria included known CAD, recent angiography, contraindications to dipyridamole, etc.

4：List of Experimental Equipment and Materials:

CZT cardiac-centered camera (D-SPECT; Spectrum Dynamics) for SPECT, whole-body PET-CT scanners (Discovery PET/CT 690 Lightspeed 64, GE Healthcare; PET-CT Biograph 6 True Point, Siemens) for PET, pressure guidewire (Radi, St. Jude Medical) for FFR measurements, radiotracers (99m-Tc-sestamibi, 82-Rb), dipyridamole for pharmacological stress, and software for image analysis (FlowQuant for PET).

5：Experimental Procedures and Operational Workflow:

For SPECT, stress protocols included exercise or pharmacological stress with dipyridamole, followed by image acquisition on CZT camera. For PET, pharmacological stress with dipyridamole was used, followed by PET acquisitions in 3D mode with CT for attenuation correction. Images were analyzed by blinded nuclear cardiologists. Coronary angiography was performed for positive cases with FFR measurements.

6：Data Analysis Methods:

Statistical analysis using McNemar's test for sensitivity and specificity comparisons, ROC analysis for diagnostic performance, and multivariable models. Software used: SAS V.9.4.