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Heart failure is a common clinical syndrome associated with significant morbidity and mortality worldwide. Ischemic heart disease is the leading cause of heart failure, at least in the industrialized countries. Proper diagnosis of the syndrome and management of patients with heart failure require anatomical and functional information obtained through various imaging modalities. Nuclear cardiology techniques play a main role in the evaluation of heart failure. Myocardial single photon emission computed tomography (SPECT) with thallium-201 or technetium-99 m labelled tracers offer valuable data regarding ventricular function, myocardial perfusion, viability, and intraventricular synchronism. Moreover, positron emission tomography (PET) permits accurate evaluation of myocardial perfusion, metabolism, and viability, providing high-quality images and the ability of quantitative analysis. As these imaging techniques assess different parameters of cardiac structure and function, variations of sensitivity and specificity have been reported among them. In addition, the role of SPECT and PET guided therapy remains controversial. In this comprehensive review, we address these controversies and report the advances in patient's investigation with SPECT and PET in ischemic heart failure. Furthermore, we present the innovations in technology that are expected to strengthen the role of nuclear cardiology modalities in the investigation of heart failure.

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The I-131 whole-body scan is a useful test to investigate the presence of metastatic disease of thyroid cancer after thyroidectomy. A 53-year-old woman received I-131 4 months after total thyroidectomy for papillary thyroid carcinoma for postsurgical ablation of the residual tumor cells. Whole-body scan demonstrated focal uptake of I-131 in the right iliac fossa that persisted 2 days later even after administration of laxatives. Computed tomography of this area showed only focal bowel scar presumably resulting from a complicated appendectomy 31 years ago. Intestinal adhesions accumulate I-131 and give false-positive activity on whole-body I-131 scans.

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