MYOCARDIAL SCINTIGRAPHY

Nuclear cardiology continues to be of particular importance in nuclear medicine. In this domain, myocardial scintigraphy has become the emin ent diagnostic tool in the diagnosis of cardiac disorders like coronar y artery disease, myocarditis, heart transplant rejection, chemotherap y-induced cardiotoxicity, and others. In a comparison of the latest wo rldwide trends, European investigators seem to be more interested in r ecently developed myocardial tracers than those in the US. Besides res earch into antimyosin monoclonal antibodies for the detection of myoca rdial damage. the technetium 99m-labeled perfusion markers are being s tudied as potential substitutes for thallous chloride TI 201. In recen t years, the dual use of (TlCl)-Tl-201/Tc-99m-sestamibi taught us the comparable clinical value of these two radiopharmaceuticals in the det ection of coronary artery disease. In the future, additional Tc-99m-la beled perfusion markers may contribute to the ongoing decrease in thal lium's widespread use. In the area of viability (ie, the preinterventi onal detection of potentially reversible myocardial wall motion abnorm alities), (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 fu ture, the limited number of these sophisticated but expensive positron emission tomography centers will not satisfy the growing clinical dem and for viability studies. Thus, European nuclear cardiologists are de veloping 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. Su ch a low-cost solution becomes more and more attractive for those nucl ear cardiologists who cannot afford a positron emission tomography sca nner, but who are close enough to a cyclotron producing positron-emitt ing radiopharmaceuticals. (C) 1995 by W.B. Saunders Company