Debate: Molecular cardiac imaging is ready for the prime time con between wishful thinking and reality

Abstract

Molecular imaging is defined as the non-invasive visualization, characterization, and measurement of biological processes at the molecular and cellular levels in humans. According to this definition, all nuclear cardiology examinations, from classic myocardial perfusion thallium scans to advanced PET studies of cardiovascular metabolism and function, can be considered molecular imaging techniques. From this perspective, it is a misconception to apply the definition of molecular cardiac imaging, only to innovative new technologies to come. Needless to say that myocardial perfusion SPECT, a classic cardiac molecular imaging technology, has been in Prime Time for decades. Having said so, it is remarkable that over the years, molecular imaging in medicine has been often unconsciously driven by wishful thinking. Typically, when an exciting new molecular imaging technology is proposed, all may seem to go well for some time, but reality eventually sets in, showing that initial expectations were based on wishes and hopes rather than on appropriate appraisal of the clinical needs and health care scenarios. Beyond wishful thinking, new molecular cardiovascular imaging techniques need to address significant issues prior to entering Prime Time. To be ready for Prime Time, new molecular cardiac imaging examinations have to overcome several major hurdles: