Assessment of myocardial viability by radionuclide imaging

The differentiation of viable from non viable myocardium is a key issue in the current era of revascularization. Several methods have been used to assess myocardial viability. The radionuclide detection of dysfunctional but viable myocardium depends upon the use of radiotracers whose uptake and trapping are related to presence and amount of living cells. The choice of the diagnostic technique to be applied in clinical practice depends on accuracy of the method and availability of resources. SPECT imaging with TI-201 and Tc-99m-myocardial perfusion tracers are widely available diagnostic tools. Several studies have documented their reliability to detect myocardial segments which may improve in both perfusion and function after revascularization. Positron emission tomography after injection of glucose analogues is a more sophisticated and accurate technology to detect viability, whose utilization is at present limited to few centers due to its high cost. Therefore an accurate selection of patients requiring viability studies is needed in order to identify the most appropriate diagnostic test.