Abstract
The use of cardiac imaging modalities has grown steadily, and cardiac nuclear studies constitute a large part of this number. Nuclear Cardiology is often mistakenly considered a synonym of myocardial perfusion imaging (MPI), but has broader applications, including metabolic imaging, innervation imaging, among other technologies. MPI has been a powerful diagnostic and prognostic tool in the assessment of patients for known or suspected CAD for decades, and is now increasingly used for the evaluation of the anti-ischemic effects of various therapies, according to changes in left ventricular perfusion defect size defined by sequential MPI. Neuronal dysfunction identified with iodine-123-metaiodobenzylguanidine may give information on prognosis in different disease conditions, such as after myocardial infarction, in diabetes and dilated cardiomyopathy. Molecular imaging may identify the predominant cellular population in the atherosclerotic plaque and help predict the likelihood of clinical events. Therefore, although its usefulness is well established, Nuclear Cardiology remains a moving science, whose roles keep in pace with evolving clinical needs and expectations.
Highlights
MYOCARDIAL PERFUSION IMAGINGFor the last 2 decades, myocardial perfusion imaging (MPI) has been an essential part of the diagnostic and prognostic assessment of patients for known or suspected coronary artery disease (CAD)
The use of cardiac imaging modalities has grown steadily, and cardiac nuclear studies constitute a large part of this number
It is most effective when used in patients with an intermediate pretest likelihood of coronary artery disease (CAD), since if the likelihood is low, a perfusion abnormality may be a false-positive finding, while in those with a high pretest likelihood of CAD a normal myocardial perfusion imaging (MPI) study may be a false-negative for the presence of angiographically significant coronary obstruction and the test may not able to exclude the presence of CAD
Summary
For the last 2 decades, MPI has been an essential part of the diagnostic and prognostic assessment of patients for known or suspected CAD. As time went by and new demands and technologies have been developed, other applications of MPI have emerged, and its roles have advanced continuously. In the 1980’s, planar and tomographic (single photon emission computed tomography, SPECT) perfusion imaging was found to reliably diagnose CAD [1,2]. In the 1990’s the prognostic value of MPI was defined [3,4,5]. With the advent of gating, left ventricular ejection fraction could be obtained, providing additional diagnostic and prognostic information [6,7]
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