Clinical Nuclear Cardiology: Practical Applications and Future Directions

Shinro Matsuo

• Publisher: Bentham Science Publishers
• Year: 2018
• Print ISBN:
  9781681087610
• eBook ISBN:
  9781681087603
• Topic: Medicine
• Subtopic: Cardiology

Nuclear cardiology is critical for the medical evaluation of patients with heart disease. Clinical Nuclear Cardiology: Practical Applications and Future Directions is the second volume of this series. The volume provides information about the clinical app.

Positron Emission Tomography Myocardial Perfusion Imaging

Keiichiro Yoshinaga^{1, *}, Osamu Manabe²

¹ Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Sciences, Chiba, Japan

² Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Abstract

With the increasing availability of positron emission tomography (PET) myocardial perfusion imaging (MPI), PET MPI and the absolute quantification of myocardial blood flow (MBF) have become popular in clinical settings [1]. PET MPI shows higher diagnostic accuracy than that of single-photon emission computed tomography (SPECT) and shows predictive value for cardiac events [2, 3]. Quantitative MBF assessment also provides important additional diagnostic or prognostic information over that attained through conventional visual assessment [4]. The success of MBF quantification using PET/computed tomography (CT) has increased demand for this quantitative diagnostic approach to be more accessible. In this regard, MBF quantification approaches have been developed using several other diagnostic imaging modalities including SPECT, dynamic CT perfusion imaging, and cardiac magnetic resonance (CMR). In the United States (US), the Food and Drug Administration (FDA) has approved ¹³N-ammonia (¹³N-NH₃) and ⁸²rubidium (⁸²Rb) for clinical use [5]. The Japanese Ministry of Health, Labour and Welfare (JMHLW) approved ¹³N-NH₃ PET MPI for diagnosis of coronary artery disease (CAD) in March 2012 but has not approved other PET MPI tracers [6, 7]. Since ¹³N-NH₃ PET MPI will be addressed elsewhere in this e-book, this review will address the clinical aspects of PET/CT MPI using other PET flow tracers.

Keywords: Blood Flow, Coronary Artery Disease, Endothelial Function, Flow Reserve, Positron Emission Tomography, Quantification.

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^* Corresponding author Keiichiro Yoshinaga: Diagnostic and Therapeutic Nuclear Medicine, National Institutes for Quantum and Radiological Science and Technology, National Institute of Radiological Sciences 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan; Tel: [phone]; Fax: [phone]; E-mail: [email protected]

TRACERS FOR PET MYOCARDIAL PERFUSION IMAGING

PET MPI tracers can be divided into (a) inert freely diffusible tracers such as O-15-labeled water (¹⁵O-H₂O) and (b) physiologically retained tracers such as

¹³N-NH₃, ⁸²Rb, and ¹⁸F-flurpiridaz [8]. The basic characteristics of commonly used PET MPI tracers are listed in (Table 1).

Among these commonly used tracers, physically retained tracers can be used to produce standard tomographic images similar to those with SPECT MPI. Therefore, these tracers can be used in clinical settings. The FDA has approved these tracers for clinical use. On the other hand, it is difficult to create static images using freely diffusible tracers, and these tracers are therefore used mainly in research settings [9].

Rubidium-82

⁸²Rb is produced from a ⁸²strontium (⁸²Sr) /⁸²Rb generator which can be eluted every 10 minutes (Fig. 1) [10, 11]. Since ⁸²Rb production does not require an on-site cyclotron, ⁸²Rb is the most widely used tracer in PET centers [12, 13]. The physical half-life of the parent isotope is 25.5 days. Thus, the shelf life of the generator is 4 to 6 weeks. In 2016, the FDA granted additional approval of a different pharmaceutical company’s ⁸²Sr/⁸²Rb generator. The more recently approved generator can be used for 6 to 8 weeks and has a longer shelf life [14].

Fig. (1))
A conceptual diagram of a ⁸²Rb infusion system that can control the ⁸²Rb activity infusion profile. The generator valve is modulated to control the concentration of ⁸²Rb activity administered to the patient. The radioactivity counter is used by the control system and for QA. The system can also flush the activity from the patient line at the end of the infusion. (Permission ...

Table of contents

• Welcome
• Table of Contents
• Title
• BENTHAM SCIENCE PUBLISHERS LTD.
• FOREWORD
• PREFACE
• List of Contributors
• Diagnosis of Coronary Artery Disease with Myocardial Perfusion Imaging
• Gated Myocardial Perfusion Imaging and Risk-Stratification in Coronary Artery Disease and Heart Failure
• Myocardial Viability Assessment in Predicting Prognosis and Providing Optimal Management for Ischemic Left Ventricular Dysfunction
• Cardiac Hybrid or Fusion Imaging and Future Prospective
• Positron Emission Tomography Myocardial Perfusion Imaging
• Myocardial Perfusion Imaging and other Modalities
• Fatty Acid Imaging from Basic to Clinical
• Recent Advances in BMIPP Imaging
• Potential Uses of 123mIBG and Analogous PET Tracers to Guide Use of Cardiac Implantable Electronic Devices in Heart Failure and Associated Arrhythmias
• Neurotransmitter Imaging for Cardiomyopathy and Takotsubo Syndrome
• Evaluation of Cardiac Sympathetic Nerve Function using Iodine-123 Metaiodobenzylguanidine Scintigraphy
• Standardization of 123I-meta-iodobenzylguanidine Heart-To-Mediastinum Ratio: Technical Aspects
• Image Diagnosis of Arteriosclerosis and Possibility of Early Intervention
• Nuclear Cardiology for the Diagnosis of Takotsubo Syndrome
• Small Rodent Animal Positron Emission Tomography/Single Photon Emission Tomography