Recent Advances in Nuclear Cardiology

Abstract

Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these challenges, remarkable achievements and improvements are currently in progress in the field of myocardial perfusion imaging regarding the applicable software and hardware. Additionally, myocardial perfusion positron emission tomography (PET) is receiving increasing attention owing to its unique capability of absolute myocardial blood flow estimation. An F-18-labeled perfusion agent for PET is under clinical trial with promising interim results. The applications of F-18 fluorodeoxyglucose (FDG) and F-18 sodium fluoride (NaF) to cardiovascular diseases have revealed details on the basic pathophysiology of ischemic heart diseases. PET/MRI seems to be particularly promising for nuclear cardiology in the future. Restrictive diseases, such as cardiac sarcoidosis and amyloidosis, are effectively evaluated using a variety of nuclear imaging tools. Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine.

Current status of myocardial perfusion imaging radiopharmaceuticals for SPECT and PET imaging modalities

“…30 It has been investigated in phase III clinical trials. 7 The studies show that F-18 flurpiridaz with PET myocardial imaging had higher sensitivity and similar specificity than the patients undergoing invasive angiography. 31 F-18 flurpiridaz may provide an important development in current noninvasive imaging of CAD based on its favorable dosimetry, linear extraction across MBF, improved spatial resolution and longer half-life.…”

“…26 F-18 FDG uptake is established to determine myocardial viability. 7 It is taken into the myocardial cell and undergone phosphorylation like the same mechanism of glucose. 23 Unlike glucose, the resulting F-18 FDG 6-phosphate (approximately 1% to 4% of injected dose) trapped in the myocyte because it is not metabolized.…”

“…Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine. 7 Although current tracers used for perfusion imaging have provided valuable clinical information, further advances are needed to enhance the detection rate of coronary artery lesions as well as the capability of monitoring subtle changes in defect size with medical therapy aimed at alleviating stress-induced ischemia and/or improving coronary endothelial function. 4 The purpose of this article review property of current and future SPECT or PET radiopharmaceuticals for MPI.…”

Nuclear Cardiology in the Era of Precision Medicine: Tailoring Treatment to the Individual Patient

“…The development of hybrid imaging systems, such as PET/CT and SPECT/CT, combines anatomical and functional imaging, providing a more comprehensive assessment of cardiovascular disease. Additionally, the advent of novel radiotracers targeting specific molecular pathways offers the potential for the early detection of cardiovascular pathologies at a cellular or molecular level [7].…”

Technetium-99m Radiopharmaceuticals for Ideal Myocardial Perfusion Imaging: Lost and Found Opportunities

“…The high initial absorption of the heart, combined with longer myocardial retention and high heart/background ratios, suggests that [ 99m Tc]Tc-3SPboroxime may become a candidate for future clinical translation through the new ultrafast CZT-SPECT detectors. Using these new SPECT cameras, a myocardial tomography can be realized in less than 5 min with half of the dose normally administered with conventional SPECT imaging devices, and, moreover, simultaneous dual-tracer protocols can be applied [63][64][65][66][67][68].…”