A novel PET radiotracer, Flurpiridaz F 18, has undergone phase II clinical trial evaluation as a high-resolution PET cardiac perfusion imaging agent. In a subgroup of patients imaged with this agent, we assessed the feasibility and benefit of simultaneous correction of respiratory and cardiac motion. Methods: In 16 patients, PET imaging was performed on a 4-ring scanner in dual cardiac and respiratory gating mode. Four sets of data were reconstructed with high-definition reconstruction (HD•PET): ungated and 8-bin electrocardiographygated images using 5-min acquisition, optimal respiratory gating (ORG)-as developed for oncologic imaging-using a narrow range of breathing amplitude around end-expiration level with 35% of the counts in a 7-min acquisition, and 4-bin respiration-gated and 8-bin electrocardiography-gated images (32 bins in total) using the 7-min acquisition (dual-gating, using all data). Motion-frozen (MF) registration algorithms were applied to electrocardiography-gated and dual-gated data, creating cardiac-MF and dual-MF images. We computed wall thickness, wall/cavity contrast, and contrast-to-noise ratio for standard, ORG, cardiac-MF, and dual-MF images to assess image quality. Results: The wall/cavity contrast was similar for ungated (9.3 ± 2.9) and ORG (9.5 ± 3.2) images and improved for cardiac-MF (10.8 ± 3.6) and dual-MF images (14.8 ± 8.0) (P , 0.05). The contrast-to-noise ratio was 22.2 ± 9.1 with ungated, 24.7 ± 12.2 with ORG, 35.5 ± 12.8 with cardiac-MF, and 42.1 ± 13.2 with dual-MF images (all P , 0.05). The wall thickness was significantly decreased (P , 0.05) with dual-MF (11.6 ± 1.9 mm) compared with ungated (13.9 ± 2.8 mm), ORG (13.1 ± 2.9 mm), and cardiac-MF images (12.1 ± 2.7 mm). Conclusion: Dual (respiratory/cardiac)-gated perfusion imaging with Flurpiridaz F 18 is feasible and improves image resolution, contrast, and contrastto-noise ratio when MF registration methods are applied. (2) and better image quality, interpretative certainty, and diagnostic performance than SPECT in a phase 2 clinical trial (3). In particular, imaging with this 18 F-based radiotracer generated higher-resolution cardiac images (4).However, the high image resolution associated with an 18 F-based tracer can be degraded by cardiac and respiratory motion during PET acquisition, leading to image blurring. If such motion is not corrected, the full-potential imaging resolution of Flurpiridaz F 18 may not be realized. We have previously developed a motion-frozen (MF) technique for myocardial perfusion imaging, which recovers resolution lost due to cardiac motion, improving contrast and quantitative diagnostic accuracy (5,6). This technique was also successfully used for automatic coregistration of SPECT with CT angiography (CTA) (7,8) and for contrast improvement in cardiac PET (9).The aim of this study was to investigate the feasibility of myocardial perfusion imaging by Flurpiridaz F 18 PET with correction of both cardiac and respiratory motion. We hypothesized that the myocardial perfusion image quality for F...