Artificial Intelligence in Nuclear Cardiac Imaging: Novel Advances, Emerging Techniques, and Recent Clinical Trials

Cardiovascular disease (CVD) is a leading cause of death, accounting for over 30% of annual global fatalities. Ischemic heart disease, in turn, is a frontrunner of worldwide CVD mortality. With the burden of coronary disease rapidly growing, understanding the nuances of cardiac imaging and risk prognostication becomes paramount. Myocardial perfusion imaging (MPI) is a frequently utilized and well established testing modality due to its significant clinical impact in disease diagnosis and risk assessment. Recently, nuclear cardiology has witnessed major advancements, driven by innovations in novel imaging technologies and improved understanding of cardiovascular pathophysiology. Applications of artificial intelligence (AI) to MPI have enhanced diagnostic accuracy, risk stratification, and therapeutic decision-making in patients with coronary artery disease (CAD). AI techniques such as machine learning (ML) and deep learning (DL) neural networks offer new interpretations of immense data fields, acquired through cardiovascular imaging modalities such as nuclear medicine (NM). Recently, AI algorithms have been employed to enhance image reconstruction, reduce noise, and assist in the interpretation of complex datasets. The rise of AI in nuclear medicine (AI-NM) has proven itself groundbreaking in the efficiency of image acquisition, post-processing time, diagnostic ability, consistency, and even in risk-stratification and outcome prognostication. To that end, this narrative review will explore these latest advances in AI in nuclear medicine and its rapid transformation of the cardiac diagnostics landscape. This paper will examine the evolution of AI-NM, review novel AI techniques and applications in nuclear cardiac imaging, summarize recent AI-NM clinical trials, and explore the technical and clinical challenges in its implementation of artificial intelligence.