American Society Of Nuclear Cardiology Research Articles

Cardiac Amyloidosis Imaging, Part 1: Amyloidosis Etiology and Image Acquisition.

Cardiac amyloidosis is a systemic form of amyloidosis in which protein-based infiltrates are deposited in myocardial extracellular space. The accumulation of amyloid fibrils causes the myocardium to thicken and stiffen, leading to diastolic dysfunction and, eventually, heart failure. Until recently, cardiac amyloidosis was considered rare. However, the recent adoption of noninvasive diagnostic testing, including 99mTc-pyrophosphate imaging, has revealed a previously undiagnosed sizable disease prevalence. Light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), the 2 primary types, account for 95% of cardiac amyloidosis diagnoses. AL results from plasma cell dyscrasia and has a very poor prognosis. The usual treatment for cardiac AL is chemotherapy and immunotherapy. Cardiac ATTR is more chronic, usually resulting from age-related instability and misfolding of the transthyretin protein. ATTR is treated by managing heart failure and using new pharmacotherapeutic drugs. 99mTc-pyrophosphate imaging can efficiently and effectively distinguish between ATTR and cardiac AL. Although the exact mechanism of myocardial 99mTc-pyrophosphate uptake is unknown, it is believed to bind to amyloid plaque microcalcifications. 99mTc-pyrophosphate imaging has a 97% sensitivity and nearly 100% sensitivity for identifying cardiac ATTR when the AL form of the disease is ruled out through serum free light-chain and serum and urine protein electrophoresis with immunofixation testing. Although there are no published 99mTc-pyrophosphate cardiac amyloidosis imaging guidelines, the American Society of Nuclear Cardiology, Society of Nuclear Medicine and Molecular Imaging, and others have published consensus recommendations to standardize test performance and interpretation. This article, part 1 of a 3-part series in this issue of the Journal of Nuclear Medicine Technology, describes amyloidosis etiology and cardiac amyloidosis characteristics, including the types, prevalence, signs and symptoms, and disease course. It further explains the scan acquisition protocol. Part 2 of the series focuses on image/data quantification and technical considerations. Finally, part 3 describes scan interpretation, along with the diagnosis and treatment of cardiac amyloidosis.

Hot spot imaging in cardiovascular diseases: an information statement from SNMMI, ASNC, and EANM

This information statement from the Society of Nuclear Medicine and Molecular Imaging, American Society of Nuclear Cardiology, and European Association of Nuclear Medicine describes the performance, interpretation, and reporting of hot spot imaging in nuclear cardiology. The field of nuclear cardiology has historically focused on cold spot imaging for the interpretation of myocardial ischemia and infarction. Hot spot imaging has been an important part of nuclear medicine, particularly for oncology or infection indications, and the use of hot spot imaging in nuclear cardiology continues to expand. This document focuses on image acquisition and processing, methods of quantification, indications, protocols, and reporting of hot spot imaging. Indications discussed include myocardial viability, myocardial inflammation, device or valve infection, large vessel vasculitis, valve calcification and vulnerable plaques, and cardiac amyloidosis. This document contextualizes the foundations of image quantification and highlights reporting in each indication for the cardiac nuclear imager.

Current status of nuclear cardiology practice in Latin America and the Caribbean, in the era of multimodality cardiac imaging approach: 2022 update.

Cardiovascular diseases (CVDs) are the leading cause of mortality in Latin America and the Caribbean (LAC), with the risk in men being slightly higher than in women. The coronavirus disease 2019 (COVID-19) pandemic caused a significant reduction in the number of cardiac diagnostic procedures globally and in particular in LAC. Nuclear cardiology is available in the region, but there is variability in terms of existing technology, radiopharmaceuticals, and human resources. In the region, there are 2385 single photon emission computed tomography (SPECT) and 315 PET scanners, Argentina and Brazil have the largest number. There is an increasing number of new technologies such as cadmium-zinc-telluride (CZT) cardiac-dedicated gamma cameras, SPECT/computed tomography (CT), and PET/CT. All countries performed myocardial perfusion imaging studies, mainly gated-SPECT; the rest are multi-gated acquisition, mainly for cardiac toxicity; detection of viability; rest gated SPECT in patients with dilated cardiomyopathy, and bone-avid tracer cardiac scintigraphy for transthyretin cardiac amyloidosis diagnosis. Regarding other non-nuclear cardiac imaging modalities, Argentina, Colombia, and Chile have the highest ratio of CT scanners, while Brazil, Argentina, and Chile show the highest ratio of MRI scanners. The development of nuclear cardiology and other advanced imaging modalities is challenged by the high cost of equipment, lack of equipment maintenance and service, insufficient-specific training both for imaging specialists and referring clinicians, and lack of awareness of cardiologists or other referring physicians on the clinical applications of nuclear cardiology. Another important aspect to consider is the necessity of implementing cardiac imaging multimodality training. A joint work of nuclear medicine specialists, radiologists, cardiologists, and clinicians, in general, is mandatory to achieve this goal. National, regional, and international cooperation including support from scientific professional societies such as the American Society of Nuclear Cardiology and Latin American Association of Biology and Nuclear Medicine Societies, cardiological societies, and organizations such as the International Atomic Energy Agency, and Pan American Health Organization, as well as government commitment are key factors in the overall efforts to tackle the burden of cardiovascular diseases in the region.

Highlights of the 26th Annual Scientific Session of the American Society of Nuclear Cardiology

Highlights of the 26th Annual Scientific Session of the American Society of Nuclear Cardiology

Hot Spot Imaging in Cardiovascular Diseases: An Information Statement from SNMMI, ASNC, and EANM.

This information statement from the Society of Nuclear Medicine and Molecular Imaging, American Society of Nuclear Cardiology, and European Association of Nuclear Medicine describes the performance, interpretation, and reporting of hot spot imaging in nuclear cardiology. The field of nuclear cardiology has historically focused on cold spot imaging for the interpretation of myocardial ischemia and infarction. Hot spot imaging has been an important part of nuclear medicine, particularly for oncology or infection indications, and the use of hot spot imaging in nuclear cardiology continues to expand. This document focuses on image acquisition and processing, methods of quantification, indications, protocols, and reporting of hot spot imaging. Indications discussed include myocardial viability, myocardial inflammation, device or valve infection, large vessel vasculitis, valve calcification and vulnerable plaques, and cardiac amyloidosis. This document contextualizes the foundations of image quantification and highlights reporting in each indication for the cardiac nuclear imager.

Insights into Nuclear Cardiology in the United States from the first 3 years of the ImageGuide Registry

BackgroundData registries facilitate knowledge acquisition and quality improvement. ImageGuide is a registry developed by the American Society of Nuclear Cardiology collecting data since 2015, providing insight into current nuclear cardiology practice. Methods and ResultsHIPAA de-identified data on > 100 practice- and patient-related variables from 19 US practices were obtained from ImageGuide. Continuous variables are reported as the mean ± standard deviation; discrete variables are reported as N (%). Practices were from 12 states; 9520 studies were submitted. The average patient was a 66-year-old man. Chest pain was the most common indication; 96% of studies were appropriate. Rest/stress 1-day studies were most common; stress/rest 1- and 2-day studies comprised < 5%. Tc-99 m was the most common radiopharmaceutical. Tl-201 was used in 14% of rest studies. Most studies were not corrected for attenuation. 89% were of good or better quality. 62% of studies were normal. ConclusionsPractice diversity is limited, but patient demographics are reflective of reported current practice. Most studies are appropriate and may obviate the need for invasive testing. Radiation dosimetry could be decreased with wider adoption of stress/rest studies and avoidance of Tl-201. ImageGuide will be an important tool to guide non-invasive cardiac imaging in the future.

The Continuing Relationship Between ASNC and JSNC: Joint Symposium in JSNC 2022.

The Japanese Society of Nuclear Cardiology (JSNC) and the American Society of Nuclear Cardiology (ASNC) have a relationship through a memorandum of understanding (MOU). This April, the MOU was extended for two more years. Based on this MOU, we hold a joint symposium at the JSNC annual meeting early in the summer each year. The theme of the joint symposium this year was "Inflammatory diseases of heart and large vessels". We consider the success of the joint symposium to be the fruit of the close relationship between JSNC and ASNC.

Prevalence and Clinical Significance of Incidental Cardiac Uptake of Technetium99m Hydroxydiphosphate (Tc99m-HDP) on Bone Scintigraphy

Cardiac scintigraphy with bone-avid radiotracers is considered a sensitive test for early identification of transthyretin cardiac amyloidosis (ATTR). However, the clinical implication of incidental cardiac uptake on bone scans performed for noncardiac reasons has not been studied. We examined whole body Tc99m-HDP bone scans of patients ≥60 years of age between January 2015 to December 2019 performed at our institution. Cardiac uptake was graded by trained readers in accordance with American Society of Nuclear Cardiology (ASNC) guidelines. Hospital electronic medical records were screened for clinical outcomes [heart failure (HF) and death] and relevant investigations. A total of 925 patients were analysed. Nineteen patients demonstrated cardiac uptake, of which 11 showed grade 1, 5 showed grade 2 and 3 showed grade 3 uptake. The majority (79%) were males with an average age of 82 years. Mean follow up period for cardiac uptake positive patients was 68±14 months. Forty-two percent (8/19) experienced HF episodes (36% of those with grade 1 uptake compared to 40% and 67% with grade 2 and 3 respectively). The majority (75%) required hospital admission for control of symptoms. Two (11%) had recurrent (>2) HF admissions (one grade 2, one grade 3 uptake). Thirty-one percent (6/19) underwent serial scans within 2 years, all of which demonstrated progression of cardiac uptake. Patients incidentally found to have Tc99m-HDP cardiac uptake on bone scans, including those with grade 1 uptake, experience increase in HF burden. Incidental discovery of cardiac uptake on bone scans warrants further clinical assessment and follow-up.

Non-invasive imaging in coronary syndromes: recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in collaboration with the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.

Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact.(1) Non-invasive imaging modalities play a fundamental role in the evaluation and management of patients with known or suspected CAD. Imaging end-points have served as surrogate markers in many observational studies and randomized clinical trials that evaluated the benefits of specific therapies for CAD.(2) A number of guidelines and recommendations have been published about coronary syndromes by cardiology societies and associations, but have not focused on the excellent opportunities with cardiac imaging. The recent European Society of Cardiology (ESC) 2019 guideline on chronic coronary syndromes (CCS) and 2020 guideline on acute coronary syndromes in patients presenting with non-ST-segment elevation (NSTE-ACS) highlight the importance of non-invasive imaging in the diagnosis, treatment, and risk assessment of the disease.(3)(4) The purpose of the current recommendations is to present the significant role of non-invasive imaging in coronary syndromes in more detail. These recommendations have been developed by the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE), in collaboration with the American Society of Nuclear Cardiology, the Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance, all of which have approved the final document.

The Cooperative Relationship Between ASNC and JSNC: Joint Symposium in JSNC 2021 and More!

The Japanese Society of Nuclear Cardiology (JSNC) and the American Society of Nuclear Cardiology (ASNC) has a cooperative relationship through a memorandum of understanding (MOU), based on which we hold a joint symposium in the JSNC annual meeting in early summer. In addition to the joint symposium this year, a joint webinar was held in early June. The theme of the joint symposium and webinar was cardiac amyloidosis. We consider the success of this collaborative work to be the fruit of the close friendship between JSNC and ASNC. The cooperative relationship between JSNC and ASNC will continue to grow.

Appropriate use criteria in myocardial perfusion imaging in a tertiary care hospital in South India: An audit.

Myocardial perfusion imaging (MPI) is an important investigative tool in the diagnosis and management of coronary artery disease. This investigation has seen a manifold increase in number in past decades as compared to other investigations such as cardiac magnetic resonance imaging/positron emission tomography or computed tomography. In 2005, “Appropriate use criteria (AUC) in cardiac radionuclide imaging” was formulated by the American College of Cardiology Foundation and the American Society of Nuclear Cardiology for effective use of this investigation, later revised in 2009. We assessed the appropriateness of indications for MPI in patients presenting to the nuclear medicine department of a tertiary care hospital according to the latest AUC for cardiac radionuclide imaging. This is a retrospective analysis of all cardiac perfusion scans performed from June 2019 to January 2020 in a tertiary care teaching hospital in South India. All patients' indications for MPI were assessed for appropriateness using AUC 2009 as appropriate, inappropriate, and uncertain indications by two experienced nuclear medicine physicians blinded for results of the test and hospital stay of the patients. A total of 1015 cardiac scans were performed in the given period, which were analyzed. This included 613 males and 402 females, with most of the patients aged above 60 years (n = 640; males = 385, females = 255). Most of the patients had diabetes mellitus or hypertension or both except in 161 patients (15.8%) which did not have either of the comorbidities. Chest pain and/or shortness of breath were the most common presenting complaints. The appropriate indication for imaging was found in 784 patients (77.2%), inappropriate in 121 patients (12%), and uncertain in 110 patients (10.8%). Our results showed appropriate indication to be 77.2% and inappropriate indications as 12% for MPI referrals in a tertiary care teaching hospital, similar to Western literature but can be improved further by continued teaching and awareness campaigns.

ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging.

ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging.

Practical Guide for Interpreting and Reporting Cardiac PET Measurements of Myocardial Blood Flow: An Information Statement from the American Society of Nuclear Cardiology, and the Society of Nuclear Medicine and Molecular Imaging.

One of the most exciting and useful advances in nuclear cardiology is the opportunity to measure myocardial blood flow (MBF) routinely as part of myocardial perfusion imaging (MPI) with positron emission tomography (PET). Incorporating MBF into the MPI evaluation improves diagnosis and assessment of

Ревматическая полимиалгия в клинических рекомендациях 2018–2020 гг. Часть II: диагностика васкулита

Совершенствование диагностики ревматических болезней пожилых людей и заболеваний аорты— актуальные задачи медицины. В патогенезе аневризм, расслоений, разрывов аорты важна роль воспаления и структурных изменений ее стенки, которые выявляют с помощью визуализирующих методов. Ведению ревматической полимиалгии, гигантоклеточного артериита, аневризм аорты посвящен ряд международных рекомендаций. С аортитом сопряжено до 40% случаев ревматической полимиалгии. Клиническое подозрение на него основано на выявлении асимметрии артериального давления и пульса, шума аортальной регургитации, сосудистых шумов, персистенции ревматической полимиалгии, воспалительной боли в спине, области таза и нижних конечностях. В 2020 году именно позитронно-эмиссионная томография/компьютерная томография рекомендована Итальянским обществом ревматологов для диагностики васкулита при ревматической полимиалгии во вторичном звене и Европейской федерацией головной боли для диагностики крупнососудистого гигантоклеточного артериита в неврологической практике. Приведен обзор рекомендаций Европейской ассоциации ядерной медицины, Общества ядерной медицины и молекулярной визуализации и Американского общества ядерной кардиологии по применению позитронно-эмиссионной томографии с фтордеоксиглюкозой в сочетании с компьютерной томографией (ангиографией) при васкулитах крупных сосудов и ревматической полимиалгии (2018). Они сопоставлены с клиническими руководствами, другими рекомендациями обществ ядерной медицины и новыми научными данными. Описана процедура исследования и подготовка к нему. Рассмотрены критерии оценки васкулита, предложенные для клинической практики и для клинических исследований, а также факторы, влияющие на результаты теста и их интерпретацию (атеросклероз, диабет, возраст, индекс массы тела, уровни гликемии и маркеров острой фазы). В рекомендациях обоснована польза применения позитронно-эмиссионной томографии и ее сочетания с компьютерной томографией для выявления экстракраниального васкулита и ценность компьютерной томографии-ангиографии на разных стадиях болезни. Требует усиления доказательная база стандарта времени экспозиции фтордеоксиглюкозы и пользы сочетания позитронной эмиссионной томографии с компьютерной томографией-ангиографией, в том числе для выявления рецидивов васкулита и мониторинга терапии. Необходим консенсус по раннему выполнению исследования, стандартизация оценок его результатов, обеспечение реимбурсации, внедрение новых методик визуализации сосудов черепа. В перспективе доказательный подход к ведению васкулита дополнит терагностика.

Guidance and Best Practices for Nuclear Cardiology Laboratories During the COVID-19 Pandemic: An Information Statement From ASNC and SNMMI.

Guidance and Best Practices for Nuclear Cardiology Laboratories During the COVID-19 Pandemic: An Information Statement From ASNC and SNMMI.

Utilization and Appropriateness of Transthoracic Echocardiography in Response to the COVID-19 Pandemic

Utilization and Appropriateness of Transthoracic Echocardiography in Response to the COVID-19 Pandemic

The voyage: Amalgating a social media platform through the annual scientific meeting

Social media platforms are increasingly used by professional societies for improved member engagement, to raise awareness, for advocacy and for widespread dissemination of scientific meeting highlights. This article describes the inaugural social media campaign implemented at the American Society of Nuclear Cardiology (ASNC) 2019 Scientific Meeting. Campaign strategies, including development of an interactive social media curriculum, dedicated social media ambassadors and implementation and announcement of a Tweetup, are described in detail. These efforts resulted in significantly uplifting the profile of the conference, improving attendee engagement, reinforced conference highlights, and expanded meeting reach across the world. This manuscript provides a blueprint for other professional societies considering the launch of a Social Media campaign at their scientific meetings.

Improving Quality of Clinical Diagnosis Report with Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging and Coronary Computed Tomography Angiography

Non-invasive cardiac imaging modalities including single-photon emission computed tomography myocardial perfusion image (SPECT-MPI) and coronary computed tomography angiography (CTA) have been widely used for diagnosis of coronary artery disease (CAD). The American Society of Nuclear Cardiology and Society of Cardiovascular Computed Tomography have recently published the guidelines for the instrumentation, acquisition, processing, interpretation, as well as reporting of SPECT and coronary CTA. These guidelines have highlighted and well documented how the imaging reporting influences medical practice for physician and treatment care for patients, suggesting that cardiac imaging reports for interpretation for patient management. This review article here summarizes improving quality of cardiac imaging reports by SPECT-MPI and coronary CTA.

Current Status of Patient Radiation Exposure of Cardiac Positron Emission Tomography and Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging.

Radiation exposure during nuclear cardiology procedures has received much attention and has prompted citations for radiation reduction. In 2010, the American Society of Nuclear Cardiology recommended reducing the average patient study radiation exposure to <9 mSv in 50% of studies by 2014. Cardiac positron emission tomography (PET) for myocardial perfusion imaging (MPI) has emerged within recent years, but current radiation exposure in cardiac nuclear PET laboratories is unknown. This study evaluated current reported patient radiation exposure from nuclear laboratories in the United States applying for Intersocietal Accreditation Commission accreditation for MPI using single photon emission computed tomography (SPECT) or PET. This was an analysis of nuclear cardiology studies submitted to the Intersocietal Accreditation Commission for either or both cardiac PET and SPECT accreditation. Cardiac SPECT data represented year 2015 while PET data combined years 2013 to 2015. Data was analyzed with χ2 and Mann-Whitney U tests (reported as median, 25th percentile, and 75th percentile). Reported PET MPI radiation exposure for 111 laboratories (532 patient cases) was 3.7 (3.2-4.1) mSv per study with no geographic variation. Reported SPECT MPI radiation exposure for 665 laboratories (3067 patient studies) was 12.8 (12.2-14.3) mSv. Highest radiation exposure was found in the South region. Technetium-only studies resulted in a median of 12.2 mSv per study. Radiation exposure from cardiac PET MPI in US laboratories applying for Intersocietal Accreditation Commission accreditation is low (111 laboratories, 3.7 mSv) and substantially lower than cardiac SPECT (665 laboratories, 12.8 mSv).

Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring: Addition to the Expert Consensus.

TO THE EDITOR: Although the joint Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the American Society of Nuclear Cardiology (ASNC) expert consensus ([1][1]) document has provided a comprehensive review on the role of 18F-FDG PET/CT in cardiac sarcoid (CS) detection and therapy