82-Rubidium—the dawn of cardiac PET in Europe?

Excerpt

An ever-increasing body of evidence has been published over the last two decades providing the ground based on which nuclear cardiology is now an accepted well-validated, cost-effective non-invasive imaging tool for the diagnostic and prognostic assessment of coronary artery disease. Nevertheless, the number of myocardial perfusion imaging (MPI) studies performed in Europe is low not only compared with the number of MPI performed in the USA, but also from that which would be expected on the basis of epidemiological data. A recent survey on the regulatory background of nuclear cardiology in Europe [1] performed by the European Council of Nuclear Cardiology (ECNC, http://​www.​ecnc-nuclearcardiolog​y.​org/​index.​php) has pointed out several issues, which may contribute to this situation. In Europe, Nuclear Medicine is a restricted and closely regulated specialty, which on one hand guarantees the quality and safe use of radionuclide. On the other hand, however, it may limit integration of Nuclear Cardiology into the clinical cardiology arena. In fact, cardiologists need to be more involved in nuclear cardiology, otherwise the demonstration that MPI is of clinical value may remain of academic interest. With regards to MPI positron emission tomography (PET) scanning, the situation is even more worrying. Although with the widespread use of oncology PET scanning the availability of scanners has dramatically increased, this has not yet caused a substantial rise in cardiac PET scanning. An ideal flow tracer should be readily available, have a short half-life for repeat rest and stress MPI with negligible waiting time, have a linear extraction rate over a wide range of flow independent of metabolism and deliver low radiation to patient and staff. Although ¹⁵O-labelled water may appear closest to such ideal properties, its clinical use is prevented by the fact that it requires high-end post processing as it does not provide clinically useful images. ¹³N-ammonia is an excellent alternative allowing to obtain images similar to SPECT because this compound is accumulated into myocardial cells by linear extraction over an acceptably wide range of flow. However, both compounds are limited by the fact that they require an on-site cyclotron due to the short half-life of the isotope (9.8 min for ¹³N; 2 min for ¹⁵O). …