Cardiovascular imaging

Nuclear cardiology has grown exponentially over the past decade. The introduction of the gamma camera, the development of new radionuclides, and the implementation of computers have transformed the field of nuclear cardiology from largely research in the 1970s to routine clinical applications in the 1980s. At first, noninvasive nuclear imaging techniques were used predominantly to aid disease detection. In the ensuing years, emphasis has shifted to the functional assessment of patients with known disease. Widely available noninvasive techniques now allow the quantitative assessment of left and right ventricular function, one of the most important predictors of survival in patients with cardiac disease. Exercise radionuclide ventriculography provides valuable information on the myocardial reserve in patients with normal resting function. The serial measurement of the ventricular ejection fraction assists in the timing of valvular replacement therapy. In patients receiving doxorubicin, serial ejection fraction follow-up helps prevent the development of irreversible, drug-induced cardiomyopathy. It is now generally acknowledged that the detection of latent coronary disease is improved by the addition of 201T1 imaging to the standard exercise electrocardiogram. Thallium imaging and infarct avid imaging with /sup 99m/Tc-pyrophosphate have proven useful in quantifying myocardial infarction size, and in assessing the value of therapy aimed at limiting infarction extent. In the evaluation of coronary artery disease, scintigraphy provides physiologic data that complements angiography, which is more anatomic. An angiographic lesion, read as a 70 percent narrowing, may not necessarily be flow-limiting, whereas one read as 40 percent, may, in fact, have physiologic consequences, if it is of sufficient length or eccentricity, or is in series with another insignificant stenosis