Abstract
Nuclear cardiology has experienced exponential growth within the past four decades with converging capacity to diagnose and influence management of a variety of cardiovascular diseases. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) with technetium-99m radiotracers or thallium-201 has dominated the field; however new hardware and software designs that optimize image quality with reduced radiation exposure are fuelling a resurgence of interest at the preclinical and clinical levels to expand beyond MPI. Other imaging modalities including positron emission tomography (PET) and magnetic resonance imaging (MRI) continue to emerge as powerful players with an expanded capacity to diagnose a variety of cardiac conditions. At the forefront of this resurgence is the development of novel target vectors based on an enhanced understanding of the underlying pathophysiological process in the subcellular domain. Molecular imaging with novel radiopharmaceuticals engineered to target a specific subcellular process has the capacity to improve diagnostic accuracy and deliver enhanced prognostic information to alter management. This paper, while not comprehensive, will review the recent advancements in radiotracer development for SPECT and PET MPI, autonomic dysfunction, apoptosis, atherosclerotic plaques, metabolism, and viability. The relevant radiochemistry and preclinical and clinical development in addition to molecular imaging with emerging modalities such as cardiac MRI and PET-MR will be discussed.
Highlights
Planar, Single photon emission computed tomography (SPECT) and positron emission tomography (PET) Imaging, Radiotracers, and Molecular ImagingThe field of Nuclear Cardiology has rapidly expanded in the last four decades, which reflects an innovative and imaginative transition from subjective interpretations of planar images with less than ideal radiotracers to a digitallybased quantitative approach
The COURAGE trial showed no difference in longterm outcome, the nuclear substudy arm did demonstrate that patients in the percutaneous coronary angiography (PCI) + optimal medical therapy (OMT) arm had a significant reduction in ischemia (33% versus 19%; P = 0.0004)
In a prospective assessment of 375 asymptomatic hemodialysis patients imaged with 123I-BMIPP versus 201Tl SPECT for 3.6 ± 1.0 years, the survival analysis showed that cardiac death-free survival rates at 3 years were 61% in patients imaged with 123I-BMIPP SPECT versus 98%
Summary
The field of Nuclear Cardiology has rapidly expanded in the last four decades, which reflects an innovative and imaginative transition from subjective interpretations of planar images with less than ideal radiotracers to a digitallybased quantitative approach. The rapid progression from planar imaging to single photon emission tomography (SPECT), positron emission tomography (PET) and magnetic resonance imaging (MRI) have been matched by an impressive progression and optimization of novel radiotracers that reflect the underlying molecular physiology of a variety of cardiac disease states. BioMed Research International exposure while maintaining image quality [1,2,3,4,5] New hardware designs such as dual modality systems (SPECT-CT, PET-CT, and PET-MR) and dedicated cardiac cameras with optimal detector geometric arrays, linear count statistics, and count rate response allow for lower-dose imaging, reduced scan time, and improved image quality [6, 7]. Critical to the success of the past forty years was a drive to continuously understand the molecular processes underlying certain cardiac disease states and the development of novel radiopharmaceuticals that more suitably match this basic understanding. Combined advances in technology and radiopharmaceutical development have driven these changes prompting more powerful disease detection at earlier stages which portends earlier intervention, improved risk stratification, optimized diagnostic accuracy, and improved prognosis
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