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Updated: Sep 10, 2025

In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography

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Radionuclide imaging techniques for assessing myocardial viability: Clinical applications, evidence, and future

Jonathan D Knott1, Ellen Kronzer1, Nandan Anavekar1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

Progress in Cardiovascular Diseases
|August 20, 2025
PubMed

Insights

Radionuclide imaging, including SPECT and PET, assesses myocardial viability in ischemic cardiomyopathy. While PET offers superior accuracy, SPECT remains accessible, guiding treatment decisions for heart failure patients.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Medical Imaging

Background:

  • Ischemic cardiomyopathy (ICM) is a primary cause of heart failure worldwide.
  • Myocardial viability testing identifies potentially reversible heart muscle dysfunction in ICM patients.
  • Radionuclide imaging plays a crucial role in assessing myocardial viability.

Purpose of the Study:

  • To review the clinical application and diagnostic performance of radionuclide imaging techniques for myocardial viability assessment in ICM.
  • To compare the utility of thallium-201 (201Tl) SPECT, technetium-99m (99mTc) SPECT, and fluorine-18-fluorodeoxyglucose (18F-FDG) PET.

Main Methods:

  • Review of clinical applications and diagnostic performance of 201Tl SPECT, 99mTc SPECT, and 18F-FDG PET.
  • Evaluation of imaging characteristics, protocols, and results for each modality.
  • Analysis of study outcomes associating viability with revascularization benefits.

Main Results:

  • 201Tl SPECT uses uptake and redistribution but has limitations in protocol length and image quality.
  • 99mTc SPECT offers improved resolution and faster imaging, enhanced with nitrate or gating.
  • 18F-FDG PET is the gold standard due to superior sensitivity, image quality, and quantitative myocardial blood flow assessment.

Conclusions:

  • Radionuclide imaging is valuable for assessing myocardial viability in ICM.
  • PET provides superior diagnostic accuracy, while SPECT remains widely accessible.
  • Further research with advanced imaging and therapies is needed to refine viability testing's role in revascularization strategies.

Keywords:
Ischemic cardiomyopathyMyocardial viabilityPositron emission tomographyRadionuclide viability testingSingle positron emission tomography

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