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346 Myocardial Imaging Products : Continuing Evolution For The Better

with FDG on PET image, would help plan, or confirm evolved well over time, with mapping the blood flow
18
the plan, for the subsequent interventions required to myocardium remaining the major procedure, per-
(or otherwise). FDG, well-known for its contributions formed using potassium ionic analogs: 201 Tl , NH ,
13
+
+
18
4
in cancer care, can be harnessed in addition for the 82 Rb , [ 99m Tc(X) ] .
+
+
n
benefit of cardiac patients. Also, many other F prod- Myocardial viability/metabolism imaging is increas-
18
ucts are under investigation, including a few under- ingly being done by the trapping of glucose analog
going clinical trials.
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123
( FDG), while use of fatty acid analog ( I - fatty acid)
has been a known sound approach since early times.
Epilogue:
SPECT and PET-CT have helped enhance the image
Myocardialimaging to elicit, sites of low or nil per-
fusion, and/or viability of the correspondingseg- quality as well as quantitation capability, strengthen-
ment(s),provides evidence-based functional informa- ing the practices further.
tion as NM’s unique support, with low radiation dose Evolution of products/techniques continues with
(5-10 mSv), for the management of cardiac patients. researchers seeking, despite many challenges,to
The recent emergence of (multi-slice) angio-CT has achieve a productspecific for atherosclerotic lesions
already added a powerful non-invasive imaging tool in the coronary arteries.
(12 mSv) to the cardiologist in the investigation of
patients of CAD; and so, what can NM and radio- Bibliography
pharmaceuticals do to further advance nuclear car- 1. N. Ramamoorthy, Meera Venkatesh,Myocardial Imaging Products’ Evo-
diology? If only there would be a suitable radiotracer lution: Change for the Better, inCardiac Imaging Update 2017, Jaypee
for i.v. use that can lit up the interiors of the coronary Brothers Medical Publishers, Delhi, 2017, pp. 80-84
arteries, almost in the same manner as the conven- 2. Vikas Veeranna and Sharmila Dorbala,Myocardial Perfusion Imaging with
tional coronary angiography shows it in cath lab, that PET, PET/CT, PET/MRI: Technical Advances and Future Applications, in
would become truly a phenomenal achievement for ‘Perfusion Imaging in Clinical Practice’, Chapter 22, Wolters Kluwer (2015)
NM, however tough the odds are in the development pp.398-411
of such a product, and in achieving the resolution 3. Oyebola O. Sogbein, Matthieu Pelletier-Galarneau, Thomas H. Schin-
of the imaging instrumentation required. Some prog- dler, LihuiWei, R. GlennWells, and Terrence D. Ruddy, Review Article:
New SPECT and PET Radiopharmaceuticals for Imaging Cardiovascular
ress in terms of potential tracers for targeting arterial Disease,Hindawi Publishing Corporation; BioMed Research International;
plaques has been reported in conferences and publi- Volume 2014, Article ID 942960
cations (e.g. by Orbay et al. cited in Bibliography). PET 4. Jamshid Maddahi and René R. S. Packard, Cardiac PET Perfusion Trac-
imaging of atherosclerosis could be of great help to ers: Current Status and Future Directions, Semin Nucl Med(2014)44:
identify the at-risk individuals earlier in the disease 333–343
process, as well as to monitor responses to thera-
py. Of the several PET tracers studied for imaging
atherosclerosis, the most commonly cited is F-FDG,
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11
while C-choline, F-galacto-RGD, C-acetate, and C-
11
11
PK11195 have been tested clinically. The small size of
the atherosclerotic lesions in coronary arteries in the
vicinity of circulating tracer in blood, taken along with
the respiratory and cardiac movements during the
image acquisition,pose high degree of uncertainties.
This could be better addressed by the use of the re-
cent development of PET-MR system, where MRI can
provide high spatial resolution and exquisite soft tis-
sue contrast, to complement the PET study.

Highlights
The volume of myocardial imaging in nuclear medi-
cine (NM) is reported to be 40-50% of all diagnostic
imaging (around 40 million studies per year) per-
formed across the world, depending upon the re-
gion/country.
The radiopharmaceuticals and techniques have

GCDC 2017