Myocardial Perfusion (SPECT) Imaging: Radiotracers and Techniques

Heart failure remains a highly prevalent disease with significant morbidity and mortality. Millions of patients are affected worldwide and their treatment is associated with a significant cost for the healthcare systems, especially in developed countries. In approximately two-third of the cases, ischemic heart disease is the cause of the syndrome. Therefore, myocardial perfusion single photon emission computed tomography (SPECT) imaging is a key element in the diagnostic investigation, prognostication, and management of patients with heart failure. Perfusion images are obtained according to various well-established protocols, after the administration of either thallium-201 or technetium-99m labelled radiotracers in combination with several stress techniques. In the future, technological innovations and improvements of reconstruction methods are expected to strengthen the role of myocardial perfusion SPECT imaging as a useful tool for the investigation of heart failure and patient’s management.

Authors: Georgoulias P, Angelidis G, Zisimopoulos A, Tsougos I.

Clinical Significance of Tetrofosmin Extracardiac Uptake During Myocardial Perfusion Imaging

Coronary artery disease (CAD) is a major cause of mortality and morbidity and its management consumes a large proportion of national healthcare budgets (Underwood et al., 2004). It has been estimated that approximately twenty diseases account for over 80% of all the deaths in the world (Satra et al., 2011). Specifically, atherosclerosis which occurs in the coronary arteries as the underlying defect responsible for CAD accounts for nearly half of these deaths. Although CAD treatment protocols are improving, its prevalence has increased. New imaging technologies have added to the immediate costs of investigation but they also have the potential to reduce overall costs, by virtue of their greater diagnostic and prognostic accuracy. This allows a more informed selection of therapy, which in turn can lead to a better clinical outcome (Underwood et al., 2004).
Myocardial perfusion scintigraphy (MPS) was developed in the 1970s and has been used increasingly in clinical cardiology since the 1980s (Underwood et al., 2004). Technical developments that have fuelled this recent increase are single-photon emission tomographic computed imaging (SPECT), pharmacological stress and ECG-gated imaging (Underwood et al., 2004). Nowadays, MPS comprises the only widely available method of assessing myocardial perfusion directly and many previously published reports support its evidence in the diagnosis of myocardial ischaemia and necrosis (Satra et al., 2011). Moreover, the prognostic value of this method for patients’ risk stratification has already been extensively reported, with an incremental prognostic value after clinical assessment, exercise electrocardiography and even above coronary angiography (Satra et al., 2011). Thus, MPS is an established imaging technique that is already an integral part of the management of CAD (diagnosis, prognostication, selection for revascularization and assessment of acute coronary syndromes) and is included in a number of professional guidelines (Underwood et al., 2004).

Panagiotis Georgoulias, Varvara Valotassiou, Ioannis Tsougos, George Angelidis and Nikolaos Demakopoulos (2011). Clinical Significance of Tetrofosm in Extracardiac Uptake During Myocardial Perfusion Imaging, Coronary Angiography - Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease, Prof. Baskot Branislav (Ed.), InTech, DOI: 10.5772/24917. 
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