MYOCARDIAL SCINTIGRAPHY

Nuclear cardiology continues to be of particular importance in nuclear medicine. In this domain, myocardial scintigraphy has become the eminent diagnostic tool in the diagnosis of cardiac disorders like coronary artery disease, myocarditis, heart transplant rejection, chemotherapy-induced cardiotoxicity, and others. In a comparison of the latest worldwide trends, European investigators seem to be more interested in recently developed myocardial tracers than those in the US. Besides research into antimyosin monoclonal antibodies for the detection of myocardial damage. the technetium 99m-labeled perfusion markers are being studied as potential substitutes for thallous chloride TI 201. In recent years, the dual use of (TlCl)-Tl-201/Tc-99m-sestamibi taught us the comparable clinical value of these two radiopharmaceuticals in the detection of coronary artery disease. In the future, additional Tc-99m-labeled perfusion markers may contribute to the ongoing decrease in thallium's widespread use. In the area of viability (ie, the preinterventional detection of potentially reversible myocardial wall motion abnormalities), (TlCl)-Tl-201 is still not fully accepted. The most reliable diagnostic tool for this procedure is N-13-NH3 (ammonia)/fluorine F18 fluorodeoxyglucose (FDG) positron emission tomography because of its options for quantification and high resolution imaging. In the near future, the limited number of these sophisticated but expensive positron emission tomography centers will not satisfy the growing clinical demand for viability studies. Thus, European nuclear cardiologists are developing alternative techniques for positron imaging. They have shown that by means of a conventional gamma camera with special high-energy collimators, a reliable perfusion/viability assessment is feasible. Such a low-cost solution becomes more and more attractive for those nuclear cardiologists who cannot afford a positron emission tomography scanner, but who are close enough to a cyclotron producing positron-emitting radiopharmaceuticals. (C) 1995 by W.B. Saunders Company