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Updated: Aug 30, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
From thallium scan to molecular imaging
Markus Schwaiger1, Frank M Bengel
1Nuklearmedizinische Klinik der TU Muenchen, Munich, Germany. m.scwaiger@lrz.tum.de
Insights
Positron emission tomography (PET) enhances cardiovascular disease diagnosis by quantifying perfusion, function, and metabolism. Advanced PET tracers assess cardiac innervation and enable non-invasive monitoring of cardiac gene therapy.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Molecular Imaging
Background:
- Cardiovascular disease (CVD) diagnosis and prognosis rely heavily on imaging techniques.
- Scintigraphic procedures, particularly perfusion imaging, are crucial for assessing coronary artery disease (CAD).
- Positron emission tomography (PET) has revolutionized quantitative assessment of cardiac function and metabolism.
Purpose of the Study:
- To review the advancements in scintigraphic procedures for cardiovascular disease evaluation.
- To highlight the role of PET in quantitative perfusion, flow reserve, and metabolic assessment.
- To discuss emerging PET applications in cardiac innervation imaging and gene therapy monitoring.
Main Methods:
- Utilizing perfusion imaging to evaluate extent, severity, and prognosis in CAD patients.
- Employing PET for quantitative assessment of myocardial perfusion and coronary flow reserve (CFR).
- Applying metabolic tracers and novel radiolabeled catecholamine analogues for assessing cardiac metabolism and innervation.
Main Results:
- PET enables quantitative assessment of perfusion and CFR, serving as an early marker of endothelial dysfunction.
- Cardiac substrate metabolism imaging identifies ischemically jeopardized myocardium.
- PET is considered the gold standard for tissue viability in advanced CAD and impaired left ventricular function (LVF).
- Innervation imaging visualizes altered sympathetic nerve terminals in conditions like diabetes and cardiomyopathy.
- Non-invasive monitoring of cardiac gene therapy using reporter genes like HSV1-tk is promising.
Conclusions:
- PET imaging offers comprehensive insights into cardiovascular pathophysiology, from perfusion and metabolism to innervation.
- Emerging PET applications hold significant potential for personalized treatment strategies and monitoring therapeutic interventions in cardiology.
- Advanced scintigraphic techniques are pivotal in improving diagnostic accuracy and prognostic evaluation for cardiovascular diseases.
Abstract:
The diagnostic and prognostic evaluation of cardiovascular diseases has been improved considerably by the application of imaging procedures. Among many, scintigraphic procedures have emerged as important diagnostic tools to assess extent, severity, and prognosis in patients with coronary artery disease (CAD). For more than the last 30 years, however, the application of perfusion imaging has been extended to allow the combined evaluation of perfusion, perfusion reserve, and ventricular function. With positron emission tomography (PET), quantitative assessment of perfusion has become possible. In combination with pharmacological stress agents, the coronary flow reserve (CFR) can be quantitatively assessed as an early marker of endothelial dysfunction. PET in combination with metabolic tracers has added the evaluation of cardiac substrate metabolism, which has become an important clinical marker for ischemically jeopardized myocardium. The PET information is widely considered as the gold standard for tissue viability in the management of patients with advanced CAD and impaired left ventricular function (LVF). New tracer approaches include the assessment of cardiac innervation, which plays an increasingly recognized role in the pathophysiology of cardiac diseases. Radiolabeled catecholamine analogues provide visualization of sympathetic nerve terminals that are functionally altered in patients with diabetes mellitus and cardiomyopathy. In addition, this scintigraphic information allows the monitoring of physiological processes such as reinnervation of the transplanted heart. New methods, such as imaging of apoptosis and gene expression, are of interest in cardiology. Combining the therapeutic gene with a reporter gene, the transfection of cardiac tissue can be monitored noninvasively. First results employing the herpes simplex virus thymidine kinase reporter gene (HSV1-tk) are encouraging and represent an attractive approach for the use of PET imaging in the control of cardiac gene therapy.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...