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NON-INVASIVE IMAGING
State of the art in nuclear cardiology
  1. Nikant Kumar Sabharwal
  1. Correspondence to Dr Nikant Kumar Sabharwal, Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; nikant.sabharwal{at}ouh.nhs.uk

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Learning objectives

  • To review the wealth of knowledge associated with myocardial perfusion scintigraphy and the newer positron emission tomography techniques

  • To understand the role of Nuclear Cardiology with other complementary techniques

  • To appreciate the other expanding roles of Nuclear Cardiology in heart failure, device infection, sympathetic innervation and dyssynchrony.

Introduction

Nuclear Cardiology is the most frequently used functional imaging test in the UK and throughout the world. It was the first test used to localise and quantify myocardial ischaemia. The wealth of evidence related to diagnosis and long-term prognosis in varying subgroups is unparalleled.1 Radionuclide ventriculography (RNV) provides a geometrically independent assessment of ventricular function which remains the gold standard. Nuclear techniques can be used in patients with renal dysfunction, obesity, dysrhythmias and claustrophobia.

Up until a few years ago, gamma camera hardware relied on the inexpensive technology of the 1960s, which has only recently undergone a revolution in response to improvements to complementary modalities. Radiation doses continue to fall.

Exciting developments in positron emission tomography (PET) and hybrid imaging are promising a bright future with a potential resurgence in popularity for this ‘workhorse’.

Technology

The mainstay of Nuclear Cardiology, myocardial perfusion scintigraphy (MPS), is performed using single photon emission computed tomography (SPECT) via a gamma camera. Worldwide, there is significant interest and investment in the role of PET in the assessment of myocardial disease.

Gamma cameras have used the scintillation properties of sodium iodide (NaI) since the 1960s. Solid-state detectors using cadmium zinc telluride (CZT) are available on modern systems which allow for a significant improvement in sensitivity, additional radiation dose reductions or reduced scanning time.2 On a new CZT system, a scan time of 4–6 min is achievable with a much lower injected dose than that used for a NaI gamma camera.

Iterative reconstruction with resolution recovery software is available for …

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