Overview

Nuclear cardiology evaluates myocardial perfusion, ventricular function, metabolism, inflammation, and amyloid deposition using radiopharmaceuticals detected by SPECT or PET.

Core Topics¶

• Test Selection — choosing between exercise ECG, stress echo, SPECT, PET, CCTA, and angiography
• Stress Testing — exercise and pharmacologic stress protocols
• SPECT — acquisition, processing, and clinical application
• PET — perfusion, myocardial blood flow, viability, and inflammation
• Cardiac Amyloidosis — bone-avid tracer imaging for ATTR
• Radiopharmaceuticals — common cardiac tracers and their properties
• Artifacts and Pitfalls — attenuation, motion, extracardiac activity, and processing errors
• Interpretation and Reporting — systematic reading and standardized reports
• Radiation Safety — patient, personnel, pregnancy, and contamination precautions

General Workflow¶

1. Confirm the clinical question.
2. Select the appropriate modality and stressor.
3. Review contraindications and patient preparation.
4. Confirm technical quality before interpretation.
5. Integrate perfusion, function, stress response, and ancillary findings.
6. Report the result clearly and communicate high-risk findings.

Common Clinical Applications¶

• Detection and risk stratification of coronary artery disease
• Assessment of myocardial viability
• Quantification of myocardial blood flow and flow reserve
• Evaluation of transthyretin cardiac amyloidosis
• Assessment of cardiac sarcoidosis or infection
• Ventricular function and mechanical synchrony
• Preoperative or post-revascularization evaluation in selected patients

Key Principles¶

• Nuclear imaging evaluates physiology rather than coronary anatomy alone.
• Exercise is preferred when feasible and clinically appropriate.
• PET generally provides better resolution, attenuation correction, and flow quantification than conventional SPECT.
• Relative perfusion imaging may underestimate balanced multivessel ischemia.
• Interpret processed images together with raw data and gated function.
• Apply radiation exposure according to the ALARA principle.

Resources¶

• American Society of Nuclear Cardiology Guidelines
• Society of Nuclear Medicine and Molecular Imaging Procedure Standards
• Atlas of Nuclear Cardiology: Imaging Companion to Braunwald's Heart Disease : Expert Consult Ami E. Iskandrian , and Ernest V. Garcia
• Nuclear Cardiology: Understanding the Basics (John J. Mahmarian, MD) October 16, 2018