Chapter

Nuclear medicine in heart failure

Pushan Bharadwaj and S. Richard Underwood

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0020

Series: Oxford Textbooks

Nuclear medicine in heart failure

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Nuclear medicine, sometimes known as molecular imaging, involvesthe characterization and measurement of biological processes in vivousing small amounts of radiolabelled tracers. It is the most sensitiveimaging technique in routine use, providing images of nano- oreven picomolar concentrations of the tracer. In patients with heartfailure (HF), biological processes such as myocardial perfusion,metabolism (both fatty acid and glucose), injury (including necrosisand apoptosis), and innervation are relevant and can be imaged.The ideal tracer is a biological molecule labelled with an isotopeof one of its constituent elements (carbon, oxygen, nitrogen, etc.),since the tracer will have biological properties identical to those ofthe natural compound. Such isotopes are positron emitters and areimaged by positron emission tomography (PET), which relies ondetecting the synchronous 511-keV photons emitted in oppositedirections when the positron annihilates with an electron in thesurrounding tissue.More common tracers use foreign elements such as iodine ortechnetium bound to a pharmaceutical that provides useful biologicalproperties. Theseradiopharmaceuticals usually emit singlegamma photons that are imaged by a gamma camera, often usingsingle photon emission computed tomography (SPECT) to producetomograms or three-dimensional images.PET has some inherent advantages over SPECT, such as higherresolution and more reliable attenuation correction that simplifies quantification of the biological process being imaged. PET is howevermore expensive and, with the exception of fluorine-18, the veryshort-lived radionuclides have to be generated on site, requiring theadditional expense of a cyclotron.

Chapter.  6214 words.  Illustrated.

Subjects: Cardiovascular Medicine ; Nuclear Medicine

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