Status of Nuclear Cardiology Progress in Japan 2020

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  • Nakajima Kenichi
    Department of Functional Imaging and Artificial Intelligence, Kanazawa University Graduate School of Medicine
  • Saito Shintaro
    Department of Nuclear Medicine, Kanazawa University Hospital
  • Yoshida Shohei
    Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science
  • Wakabayashi Hiroshi
    Department of Nuclear Medicine, Kanazawa University Hospital

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Abstract

A major achievement in nuclear cardiology has been the identification of ischemia, and multimodal imaging of coronary artery disease has been pivotal in this process. X-ray computed tomography (CT) is an imaging modality that can reveal information about coronary artery stenosis. Thus, the number of studies has rapidly increased in Japan, where CT is widely available in clinical practice. However, coronary CT angiography is more suitable for visualizing the coronary anatomy of patients with mild to intermediate risk, and nuclear cardiology is more appropriate for detecting stress-induced ischemia among patients with intermediate-to-severe risk. Solid-state SPECT cameras equipped with cadmium-zinc-telluride detectors enable dynamic data acquisition and generate information about myocardial flow reserve, which might offer a new perspective of multi-vessel diseases and the microcirculation. Artificial intelligence is emerging as a possible new strategy for identifying ischemia. The applications of 123I-labeled non-perfusion tracers have expanded in Japan. For example, 123I-BMIPP can visualize ischemic memory, help determine the prognosis of patients with chronic kidney disease or those on hemodialysis, and it has also recently proved useful for diagnosing triglyceride cardiomyovasculopathy. Although 123I-MIBG is indicated for heart failure, model-based approaches to differentially predicting causes of cardiac death are under investigation. Other applications include 99mTc-pyrophosphate imaging of transthyretin cardiac amyloidosis and 18F-FDG for cardiac sarcoidosis. Among all multimodal imaging modalities, nuclear cardiology continues to be tracer-based and reflect myocardial perfusion, flow reserve and molecular imaging.

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