Major achievements in nuclear cardiology: IIMyocardial perfusion imaging agents: SPECT and PET
Introduction
Myocardial perfusion imaging for the evaluation of regional myocardial blood flow and viability under rest or stress conditions has emerged as the major nuclear cardiology technique in clinical practice. The evolution of this technique over the years has occurred in parallel with advances in instrumentation, particularly with the transformation from planar gamma camera approaches to image acquisition to tomographic imaging with single photon emission computed tomography (SPECT) technology, which now can include gated acquisition for simultaneous assessment of function and attenuation correction for enhancing specificity with reduction in attenuation artifacts. Simultaneously, positron emission tomographic (PET) imaging has become more prevalent as an alternative approach to evaluating myocardial blood flow by use of positron-emitting radionuclides that are short-lived. 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.
Section snippets
Historical perspective
Potassium 43 (K-43) was one of the first radionuclides to be used for imaging in patients but was limited by its rather high-energy photons (373-keV peak) that made imaging with gamma cameras somewhat problematic. The tracer also had a 22.4-hour physical half-life, so studies had to be separated by a minimum of 4 days to reduce residual activity from the first procedure (eg, resting imaging). Images were obtained on a rectilinear scanner by use of planar anterior and oblique projections. When
Background
Assessment of myocardial perfusion is critical for evaluating the significance of diseases that affect the coronary artery and for evaluation of their severity. Although SPECT constitutes the primary modality for assessing myocardial perfusion with radioactive tracers, PET provides several significant advantages over SPECT imaging. These include accurate attenuation correction, because of the physical characteristics of the positron-emitting radionuclides, and the ability to quantify myocardial
Conclusions
The advent of myocardial perfusion imaging 30 years ago was a major landmark, which heralded the emergence of the field of nuclear cardiology into clinical practice. Over the years, the different tracers cited in this review have been used with SPECT or PET imaging technologies for the noninvasive evaluation of regional myocardial blood flow, which has enhanced our ability to diagnose CAD, assess prognosis, detect viable myocardium, and evaluate the efficacy of therapies aimed at improving
Acknowledgements
We acknowledge Ms Erika Laurion and Mr Jerry Curtis for assistance in the preparation of this review, as well as the contribution of our fellows and colleagues over the years.
The authors have indicated they have no financial conflicts of interest.
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