Molecular imaging is likely to play a pivotal role in the evaluation, risk stratification, and management of patients with cardiovascular disease. Targeted molecular imaging in combination with more conventional physiological imaging will allow a more “personalized” approach to the management of cardiac disease. The use of molecular imaging for the evaluation of the early molecular and cellular events associated with cardiovascular disease will allow early detection of disease and potentially improve patient outcome. The non-invasive in vivo evaluation of molecular and cellular processes could potentially also serve as endpoints for all therapies whether they are pharmacological, surgical, or even molecular target therapeutics.
These novel molecular imaging strategies will likely require hybrid imaging system, and could be used to evaluate processes involve with a wide range of cardiovascular disease; including, 1) ischemic injury, 2) heart failure, and LV remodeling, 3) thrombosis, 4) apoptosis, 5) atherosclerosis and vulnerable plaque, 6) angiogenesis, 7) immune base processes like transplant rejection, 8) arrhythmic substrate, or 9) imaging of cell-based therapies.
Existing PET and SPECT instrumentation may be insufficiently sensitive to detect the small deep lesions like coronary atherosclerosis/unstable plaque. Accordingly, investigators are developing intravascular scintillation catheters that can be used to detect local uptake of radiotracers targeted to components of the atherosclerotic or unstable vascular plaque and unique hybrid imaging systems dedicated for cardiovascular imaging.
Cardiovascular nuclear medicine studies provide highly sensitive and specific tests for evaluation of diagnosis, prognosis, and treatment response of coronary artery disease (CAD), as well as selection of patients who benefit from revascularization.
Expert panels have determined appropriate use criteria (AUC) for SPECT and PET MPI based on review of extensive scientific evidence in many thousands of patients. Appropriate Use Criteria (AUC) are published, readily available online (see link below) and on smartphones and iPad, and are widely accepted.