Pub Date : 2026-02-02DOI: 10.1016/j.nuclcard.2026.102652
Antti Saraste, Juhani Knuuti
Total-body positron emission tomography (PET) systems with a long axial field of view (LAFOV) are now commercially available and represent the state of the art in PET imaging. These systems provide wide anatomical coverage and markedly increased detection sensitivity. Clinical studies have demonstrated enhanced image quality, superior quantification, and benefits for tracer kinetic modeling through dynamic imaging. LAFOV PET/CT allows for substantial reductions in acquisition time and radiation dose while maintaining diagnostic image quality. Full-body coverage enables dynamic whole-body imaging, which enables tracer kinetic modeling across multiple organs and the large vascular structures, offering new opportunities for studying their interactions in cardiovascular and systemic diseases. Furthermore, these systems facilitate the development of new PET methods including pharmacokinetics of new tracers. This review discusses the emerging opportunities and challenges associated with the application of LAFOV PET/CT systems in cardiovascular diseases.
{"title":"New opportunities for nuclear cardiology with total-body positron emission tomography/computed tomography.","authors":"Antti Saraste, Juhani Knuuti","doi":"10.1016/j.nuclcard.2026.102652","DOIUrl":"10.1016/j.nuclcard.2026.102652","url":null,"abstract":"<p><p>Total-body positron emission tomography (PET) systems with a long axial field of view (LAFOV) are now commercially available and represent the state of the art in PET imaging. These systems provide wide anatomical coverage and markedly increased detection sensitivity. Clinical studies have demonstrated enhanced image quality, superior quantification, and benefits for tracer kinetic modeling through dynamic imaging. LAFOV PET/CT allows for substantial reductions in acquisition time and radiation dose while maintaining diagnostic image quality. Full-body coverage enables dynamic whole-body imaging, which enables tracer kinetic modeling across multiple organs and the large vascular structures, offering new opportunities for studying their interactions in cardiovascular and systemic diseases. Furthermore, these systems facilitate the development of new PET methods including pharmacokinetics of new tracers. This review discusses the emerging opportunities and challenges associated with the application of LAFOV PET/CT systems in cardiovascular diseases.</p>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102652"},"PeriodicalIF":2.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-23DOI: 10.1016/j.nuclcard.2026.102649
Jamieson M. Bourque MD, MHS, FASNC
{"title":"Developing the multimodality cardiovascular imager: The central role for nuclear cardiology —challenges and opportunities","authors":"Jamieson M. Bourque MD, MHS, FASNC","doi":"10.1016/j.nuclcard.2026.102649","DOIUrl":"10.1016/j.nuclcard.2026.102649","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"56 ","pages":"Article 102649"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-07-16DOI: 10.1016/j.nuclcard.2025.102442
Shu Wang MD , Qiu Luan MD , Zhiming Cheng MD , Yaming Li MD , Xuena Li MD
{"title":"18F-FAP-2286 and 18F-FDG PET/CT imaging in a rare case of asymptomatic indolent cardiac hemangioma in the right ventricle","authors":"Shu Wang MD , Qiu Luan MD , Zhiming Cheng MD , Yaming Li MD , Xuena Li MD","doi":"10.1016/j.nuclcard.2025.102442","DOIUrl":"10.1016/j.nuclcard.2025.102442","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"56 ","pages":"Article 102442"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.nuclcard.2025.102573
Robert JH. Miller MD , Aakash Shanbhag MSc , Karan Shahi MSc , Debra Bosley RN , Lyndsay Litwin RN , James A. White MD , Victor Jimenez-Zepeda MD , Damini Dey PhD , Daniel S. Berman MD , Nowell M. Fine MD SM , Piotr J. Slomka PhD
Background
Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure (HF) in older adults. Several therapies for ATTR-CM are now available, with more currently in development. As such, there is an increasing need for methods to assess response to therapy. We evaluated the associations between serial 99m-technetium pyrophosphate (99mTc-PYP) deep learning measurements with changes in other imaging parameters and clinical outcomes.
Methods
We included patients with a diagnosis of ATTR-CM and at least two 99mTc-PYP studies followed through the Amyloidosis Program of Calgary. Patients underwent laboratory testing, echocardiography, and cardiovascular magnetic resonance unless contraindications were present. 99mTc-PYP images were quantified using our previously developed deep learning methodology including assessment of cardiac pyrophosphate activity (CPA) and volume of involvement (VOI).
Results
In total, 85 patients were included, with a median population age of 79 years (interquartile range [IQR]: 72 – 84) and 76 (89%) male patients. In patients on therapy, there was a reduction in VOI (median: 100 to 51, P < 0.001), CPA (median: 165 to 81, P < 0.001), native T1 (median: 1400 to 1387, P = 0.005), and extracellular volume (median: 50 to 49, P = 0.035) during a median time of 369 days (IQR: 365–516) between scans. There was a modest correlation between change in CPA and change in native T1 (ρ = 0.376, P = 0.009). After adjusting for age, treatment, and CPA at follow-up, an increase in CPA during follow-up was also associated with an increased risk (adjusted hazard ratio: 2.31 per standard deviation increase, 95% confidence interval: 1.28–4.17, P = 0.005).
Conclusions
Serial 99mTc-PYP quantitation has modest correlations with other measures of disease burden including native T1. Changes in these measures were associated with risk of cardiovascular death or HF hospitalization, suggesting that the serial measurements may be clinically meaningful surrogate endpoints.
{"title":"Artificial intelligence–driven longitudinal quantification of technetium pyrophosphate uptake in cardiac amyloidosis: Correlation with multimodality imaging and outcomes","authors":"Robert JH. Miller MD , Aakash Shanbhag MSc , Karan Shahi MSc , Debra Bosley RN , Lyndsay Litwin RN , James A. White MD , Victor Jimenez-Zepeda MD , Damini Dey PhD , Daniel S. Berman MD , Nowell M. Fine MD SM , Piotr J. Slomka PhD","doi":"10.1016/j.nuclcard.2025.102573","DOIUrl":"10.1016/j.nuclcard.2025.102573","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure (HF) in older adults. Several therapies for ATTR-CM are now available, with more currently in development. As such, there is an increasing need for methods to assess response to therapy. We evaluated the associations between serial 99m-technetium pyrophosphate (<sup>99m</sup>Tc-PYP) deep learning measurements with changes in other imaging parameters and clinical outcomes.</div></div><div><h3>Methods</h3><div>We included patients with a diagnosis of ATTR-CM and at least two <sup>99m</sup>Tc-PYP studies followed through the Amyloidosis Program of Calgary. Patients underwent laboratory testing, echocardiography, and cardiovascular magnetic resonance unless contraindications were present. <sup>99m</sup>Tc-PYP images were quantified using our previously developed deep learning methodology including assessment of cardiac pyrophosphate activity (CPA) and volume of involvement (VOI).</div></div><div><h3>Results</h3><div>In total, 85 patients were included, with a median population age of 79 years (interquartile range [IQR]: 72 – 84) and 76 (89%) male patients. In patients on therapy, there was a reduction in VOI (median: 100 to 51, <em>P</em> < 0.001), CPA (median: 165 to 81, <em>P</em> < 0.001), native T1 (median: 1400 to 1387, <em>P</em> = 0.005), and extracellular volume (median: 50 to 49, <em>P</em> = 0.035) during a median time of 369 days (IQR: 365–516) between scans. There was a modest correlation between change in CPA and change in native T1 (ρ = 0.376, <em>P</em> = 0.009). After adjusting for age, treatment, and CPA at follow-up, an increase in CPA during follow-up was also associated with an increased risk (adjusted hazard ratio: 2.31 per standard deviation increase, 95% confidence interval: 1.28–4.17, <em>P</em> = 0.005).</div></div><div><h3>Conclusions</h3><div>Serial <sup>99m</sup>Tc-PYP quantitation has modest correlations with other measures of disease burden including native T1. Changes in these measures were associated with risk of cardiovascular death or HF hospitalization, suggesting that the serial measurements may be clinically meaningful surrogate endpoints.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"56 ","pages":"Article 102573"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-04DOI: 10.1016/j.nuclcard.2025.102587
Gregorio Tersalvi MD , Patricia Carey MD , Armin Garmany BS , Christopher G. Scott MS , Daniel R. Davies MD , Hayan Jouni MD , Martin G. Rodriguez-Porcel MD , J. Wells Askew MD , John P. Bois MD , Kathleen A. Young MD , Nandan S. Anavekar MBBCh , Ian C. Chang MD , Patricia A. Pellikka MD , Martha Grogan MD , Angela Dispenzieri MD , Andrew C. Homb MD , Geoffrey B. Johnson MD, PhD , Panithaya Chareonthaitawee MD , Omar F. AbouEzzeddine MDCM, MS
Background
Cardiac amyloid radionuclide imaging (CARI) with 99mTc-pyrophosphate (PYP) enables the noninvasive diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). Recent PYP shortages have necessitated substitution with 99mTc-hydroxymethylene diphosphonate (HMDP), yet direct comparative data are limited. We aimed to compare scan interpretation, ATTR-CM prevalence, and myocardial-to-blood pool discrimination between PYP and HMDP in real-world clinical practice.
Methods
We retrospectively analyzed 992 consecutive patients who underwent SPECT/CT for suspected ATTR-CM at a single referral center between October 2022 and January 2025. PYP was used except during two shortage periods (December 2023 to February 2024 and October 2024 to January 2025), when HMDP was substituted. Scan interpretation and final ATTR-CM diagnoses were recorded. The myocardial-to-blood-pool radiotracer uptake ratio (3D Score) was measured as a surrogate for contrast resolution.
Results
Of 992 unique patients (median age 76, 27% female), 816 received PYP and 176 (18%) received HMDP. Baseline clinical, echocardiographic, and biomarker characteristics were similar between groups. Rates of positive scans (PYP: 26%, HMDP: 25%; P = 0.95) and final ATTR-CM diagnoses (28% vs 26%; P = 0.59) were comparable. Among patients with positive scans (n = 256), HMDP yielded significantly higher 3D Scores (2.0 [1.7-2.5] vs 1.4 [1.2-1.7], P < 0.001), suggesting enhanced myocardial-to-blood pool contrast resolution.
Conclusions
In a large cohort with similar clinical profiles, HMDP provided equivalent diagnostic yield and superior myocardial-to-blood-pool discrimination compared to PYP. These findings support HMDP as a good alternative during PYP shortages, with potential advantages in contrast resolution.
背景：99mtc焦磷酸盐（PYP）心脏淀粉样蛋白放射性核素成像（CARI）可以无创诊断甲状腺素转淀粉样心肌病（atr - cm）。最近由于PYP短缺，必须用99mtc -羟亚甲基二膦酸盐（HMDP）替代，但直接比较数据有限。我们的目的是比较PYP和HMDP在现实世界的临床实践中的扫描解释、atr - cm患病率和心肌到血池的区别。方法：我们回顾性分析了2022年10月至2025年1月在单一转诊中心连续接受SPECT/CT诊断疑似atr - cm的992例患者。除了两个短缺时期（2023年12月至2024年2月和2024年10月至2025年1月），PYP被取代。记录扫描解释和最终的atr - cm诊断。测量心肌-血池放射性示踪剂摄取比（3D评分）作为对比分辨率的替代指标。结果：992例独特患者（中位年龄76岁，女性27%）中，816例接受PYP治疗，176例（18%）接受HMDP治疗。两组之间的基线临床、超声心动图和生物标志物特征相似。阳性扫描率（PYP: 26%, HMDP: 25%, p = 0.95）和最终atr - cm诊断率（28% vs 26%, p = 0.59）具有可比性。在扫描呈阳性的患者（n = 256）中，HMDP的3D评分明显更高（2.0 [1.7-2.5]vs 1.4 [1.2-1.7], p < 0.001），表明心肌-血池对比分辨率增强。结论：在具有相似临床概况的大型队列中，与PYP相比，HMDP提供了相同的诊断率和优越的心肌-血池鉴别。这些发现支持HMDP在PYP短缺期间作为一个很好的替代方案，在对比度分辨率方面具有潜在的优势。
{"title":"Comparative performance of 99mTc-pyrophosphate vs. 99mTc-hydroxymethylene diphosphonate for cardiac amyloid radionuclide imaging","authors":"Gregorio Tersalvi MD , Patricia Carey MD , Armin Garmany BS , Christopher G. Scott MS , Daniel R. Davies MD , Hayan Jouni MD , Martin G. Rodriguez-Porcel MD , J. Wells Askew MD , John P. Bois MD , Kathleen A. Young MD , Nandan S. Anavekar MBBCh , Ian C. Chang MD , Patricia A. Pellikka MD , Martha Grogan MD , Angela Dispenzieri MD , Andrew C. Homb MD , Geoffrey B. Johnson MD, PhD , Panithaya Chareonthaitawee MD , Omar F. AbouEzzeddine MDCM, MS","doi":"10.1016/j.nuclcard.2025.102587","DOIUrl":"10.1016/j.nuclcard.2025.102587","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac amyloid radionuclide imaging (CARI) with <sup>99m</sup>Tc-pyrophosphate (PYP) enables the noninvasive diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). Recent PYP shortages have necessitated substitution with <sup>99m</sup>Tc-hydroxymethylene diphosphonate (HMDP), yet direct comparative data are limited. We aimed to compare scan interpretation, ATTR-CM prevalence, and myocardial-to-blood pool discrimination between PYP and HMDP in real-world clinical practice.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 992 consecutive patients who underwent SPECT/CT for suspected ATTR-CM at a single referral center between October 2022 and January 2025. PYP was used except during two shortage periods (December 2023 to February 2024 and October 2024 to January 2025), when HMDP was substituted. Scan interpretation and final ATTR-CM diagnoses were recorded. The myocardial-to-blood-pool radiotracer uptake ratio (3D Score) was measured as a surrogate for contrast resolution.</div></div><div><h3>Results</h3><div>Of 992 unique patients (median age 76, 27% female), 816 received PYP and 176 (18%) received HMDP. Baseline clinical, echocardiographic, and biomarker characteristics were similar between groups. Rates of positive scans (PYP: 26%, HMDP: 25%; <em>P</em> = 0.95) and final ATTR-CM diagnoses (28% vs 26%; <em>P</em> = 0.59) were comparable. Among patients with positive scans (n = 256), HMDP yielded significantly higher 3D Scores (2.0 [1.7-2.5] vs 1.4 [1.2-1.7], <em>P</em> < 0.001), suggesting enhanced myocardial-to-blood pool contrast resolution.</div></div><div><h3>Conclusions</h3><div>In a large cohort with similar clinical profiles, HMDP provided equivalent diagnostic yield and superior myocardial-to-blood-pool discrimination compared to PYP. These findings support HMDP as a good alternative during PYP shortages, with potential advantages in contrast resolution.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"56 ","pages":"Article 102587"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-20DOI: 10.1016/j.nuclcard.2025.102565
Ke Wang MD , Xin Li MD , Shuyang Song MD , Hui Li MD , Xincao Tao MD , Wei Fang MD , Zhihui Zhao MD , Chaowu Yan MD , Lei Wang MD
Background
This study aimed to investigate the relationship between pressure overload-induced right ventricular (RV) fibrotic remodeling detected by 99mTc-fibroblast activation protein inhibitor (FAPI) single photon emission computed tomography/computed tomography (SPECT/CT) and echocardiographic biomechanical adaptation/maladaptation in chronic thromboembolic pulmonary hypertension (CTEPH).
Methods
Thirty-seven CTEPH patients scheduled for balloon pulmonary angiography (BPA) underwent baseline 99mTc-FAPI SPECT/CT, speckle-tracking echocardiography (measuring RV global strain [GS] and free-wall strain [FWS]), and right heart catheterization. Baseline RV FAPI uptake (peak myocardial-to-blood ratio, TBRpeak) was compared with RV strain and RV-pulmonary artery coupling parameters. Twenty patients received repeated BPA sessions, and a subgroup of 10 underwent repeat FAPI SPECT and strain analysis after a single BPA.
Results
Baseline global RV FAPI TBRpeak varied among CTEPH patients (mean ± SD: 2.92 ± 0.96; range: 1.44-4.76). Patients without RV uptake exhibited significantly higher strain values and preserved RV-pulmonary artery coupling compared to those with uptake. TBRpeak of free wall correlated positively with RVGS (r = 0.450, P = 0.005), RVGS/sPAP (global right ventricular longitudinal strain/systolic pulmonary artery pressure) (r = 0.370, P = 0.024), right ventricular free-wall longitudinal strain (RVFWS, r = 0.386, P = 0.018), and RVFWS/sPAP (r = 0.347, P = 0.035). Following a single BPA, RV FAPI uptake decreased in 6 of 10 patients and increased modestly in 4. Changes in FAPI uptake (global ΔTBRpeak) significantly correlated with ΔRVGS (r = 0.697, P = 0.025), ΔRVFWS (r = 0.710, P = 0.022), ΔRVGS/sPAP (r = 0.694, P = 0.026), ΔRVFWS/sPAP (r = 0.700, P = 0.024).
Conclusion
In CTEPH, RV fibrotic remodeling quantified by FAPI SPECT/CT correlated with echocardiographic RV strain and ventricular-pulmonary artery coupling. Following BPA, changes in RV FAPI uptake appeared dynamic, with fluctuations potentially corresponding to alterations in both RV strain and ventricular-pulmonary coupling parameters.
背景：本研究旨在探讨99mTc-FAPI（成纤维细胞活化蛋白抑制剂）SPECT/CT（单光子发射计算机断层扫描/计算机断层扫描）检测的慢性血栓栓塞性肺动脉高压（CTEPH）患者压力过载诱导的右心室纤维化重塑与超声心动图生物力学适应/不适应之间的关系。方法：37例计划行球囊肺血管造影（BPA）的CTEPH患者行99mTc-FAPI SPECT/CT、斑点跟踪超声心动图（测量右心室总应变[GS]和游离壁应变[FWS]）和右心导管。将基线右心室FAPI摄取（心肌血比峰值，TBRpeak）与右心室应变和右心室-肺动脉耦合参数进行比较。20例患者重复接受BPA治疗；10个亚组在单次BPA后进行了重复FAPI SPECT和应变分析。结果：基线全球RV FAPI TBRpeak在CTEPH患者中有所不同（平均±SD: 2.92±0.96；范围：1.44-4.76）。与摄取RV的患者相比，未摄取RV的患者表现出明显更高的应变值和保留的RV-肺动脉耦合。自由壁峰值与RVGS （r = 0.450, p = 0.005）、RVGS/sPAP （r = 0.370, p = 0.024）、RVFWS （r = 0.386, p = 0.018）、RVFWS/sPAP （r = 0.347, p = 0.035）呈正相关。单次BPA治疗后，6/10患者的RV FAPI摄取减少，4 /10患者略有增加。FAPI摄取变化（全球ΔTBRpeak）与ΔRVGS （r = 0.697, p = 0.025）、ΔRVFWS （r = 0.710, p = 0.022）、ΔRVGS/sPAP （r = 0.694, p = 0.026）、ΔRVFWS/sPAP （r = 0.700, p = 0.024）显著相关。结论：在CTEPH中，FAPI SPECT/CT量化的右心室纤维化重构与超声心动图右心室应变和心室-肺动脉耦合相关。BPA后，右心室FAPI摄取的变化呈动态变化，其波动可能与右心室应变和心室-肺耦合参数的改变相对应。
{"title":"Quantifying right ventricular fibrosis burden in chronic thromboembolic pulmonary hypertension via fibroblast activation protein inhibitor single photon emission computed tomography/computed tomography: Correlation with echocardiographic parameters and balloon pulmonary angiography response","authors":"Ke Wang MD , Xin Li MD , Shuyang Song MD , Hui Li MD , Xincao Tao MD , Wei Fang MD , Zhihui Zhao MD , Chaowu Yan MD , Lei Wang MD","doi":"10.1016/j.nuclcard.2025.102565","DOIUrl":"10.1016/j.nuclcard.2025.102565","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate the relationship between pressure overload-induced right ventricular (RV) fibrotic remodeling detected by <sup>99m</sup>Tc-fibroblast activation protein inhibitor (FAPI) single photon emission computed tomography/computed tomography (SPECT/CT) and echocardiographic biomechanical adaptation/maladaptation in chronic thromboembolic pulmonary hypertension (CTEPH).</div></div><div><h3>Methods</h3><div>Thirty-seven CTEPH patients scheduled for balloon pulmonary angiography (BPA) underwent baseline <sup>99m</sup>Tc-FAPI SPECT/CT, speckle-tracking echocardiography (measuring RV global strain [GS] and free-wall strain [FWS]), and right heart catheterization. Baseline RV FAPI uptake (peak myocardial-to-blood ratio, TBR<sub>peak</sub>) was compared with RV strain and RV-pulmonary artery coupling parameters. Twenty patients received repeated BPA sessions, and a subgroup of 10 underwent repeat FAPI SPECT and strain analysis after a single BPA.</div></div><div><h3>Results</h3><div>Baseline global RV FAPI TBR<sub>peak</sub> varied among CTEPH patients (mean ± SD: 2.92 ± 0.96; range: 1.44-4.76). Patients without RV uptake exhibited significantly higher strain values and preserved RV-pulmonary artery coupling compared to those with uptake. TBR<sub>peak</sub> of free wall correlated positively with RVGS (r = 0.450, <em>P</em> = 0.005), RVGS/sPAP (global right ventricular longitudinal strain/systolic pulmonary artery pressure) (r = 0.370, <em>P</em> = 0.024), right ventricular free-wall longitudinal strain (RVFWS, r = 0.386, <em>P</em> = 0.018), and RVFWS/sPAP (r = 0.347, <em>P</em> = 0.035). Following a single BPA, RV FAPI uptake decreased in 6 of 10 patients and increased modestly in 4. Changes in FAPI uptake (global ΔTBR<sub>peak</sub>) significantly correlated with ΔRVGS (r = 0.697, <em>P</em> = 0.025), ΔRVFWS (r = 0.710, <em>P</em> = 0.022), ΔRVGS/sPAP (r = 0.694, <em>P</em> = 0.026), ΔRVFWS/sPAP (r = 0.700, <em>P</em> = 0.024).</div></div><div><h3>Conclusion</h3><div>In CTEPH, RV fibrotic remodeling quantified by FAPI SPECT/CT correlated with echocardiographic RV strain and ventricular-pulmonary artery coupling. Following BPA, changes in RV FAPI uptake appeared dynamic, with fluctuations potentially corresponding to alterations in both RV strain and ventricular-pulmonary coupling parameters.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"56 ","pages":"Article 102565"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.nuclcard.2025.102574
Jessica Hagerman MSc , Shahnaz Akil Engblom PhD , Irma Cerić Andelius MSc , Anna Stenvall PhD , David Minarik PhD , Sara Hall MD, PhD , Erik Stomrud MD, PhD , Adjmal Nahimi MD, PhD , Ruben Smith MD, PhD , Oskar Hansson MD, PhD , Fredrik Hedeer MD, PhD
Background
Assessment of myocardial sympathetic innervation with iodine-123-metaiodobenzylguanidine ([123I]mIBG) scintigraphy is conventionally performed by determining the heart-to-mediastinum ratio (HMR) on planar images. This study aimed to investigate the feasibility of determining HMR from reprojected [123I]mIBG planar images derived from tomographic data by a ring-configured cadmium-zinc-telluride (CZT) gamma camera and its agreement with HMR determined from [123I]mIBG planar images by an Anger gamma camera, in the assessment of myocardial sympathetic innervation.
Methods
A total of 105 study participants (suspected idiopathic rapid-eye-movement sleep behavior disorder n = 55, early-stage Parkinson's Disease n = 36, and healthy controls n = 14) who were referred for [123I]mIBG myocardial scintigraphy were included, in addition to eight phantom experiments simulating a range of HMR. HMR was determined from planar and reprojected planar images acquired with an Anger gamma camera and a ring-configured CZT gamma camera, respectively, for all study participants and phantom experiments. Agreement in HMR between the two imaging methods was analyzed in Bland-Altman plots. Intra- and interobserver variability was evaluated for both imaging methods in a subset of images.
Results
The agreement between planar and reprojected planar images was good, with a mean difference in HMR of 0.11 (95% limits of agreement −0.16 to 0.38) for the study participants. Intra- and interobserver variability was low and comparable for both imaging methods. Results from the phantom experiments were consistent with those from the study participants.
Conclusions
Determining HMR from reprojected [123I]mIBG myocardial scintigraphy planar images acquired with a ring-configured CZT gamma camera is feasible and shows good agreement with HMR determined from planar images by a conventional Anger gamma camera.
{"title":"Assessment of myocardial sympathetic innervation with [123I]mIBG myocardial scintigraphy: A comparative study between an Anger and a ring-configured cadmium-zinc-telluride gamma camera","authors":"Jessica Hagerman MSc , Shahnaz Akil Engblom PhD , Irma Cerić Andelius MSc , Anna Stenvall PhD , David Minarik PhD , Sara Hall MD, PhD , Erik Stomrud MD, PhD , Adjmal Nahimi MD, PhD , Ruben Smith MD, PhD , Oskar Hansson MD, PhD , Fredrik Hedeer MD, PhD","doi":"10.1016/j.nuclcard.2025.102574","DOIUrl":"10.1016/j.nuclcard.2025.102574","url":null,"abstract":"<div><h3>Background</h3><div>Assessment of myocardial sympathetic innervation with iodine-123-metaiodobenzylguanidine ([<sup>123</sup>I]mIBG) scintigraphy is conventionally performed by determining the heart-to-mediastinum ratio (HMR) on planar images. This study aimed to investigate the feasibility of determining HMR from reprojected [<sup>123</sup>I]mIBG planar images derived from tomographic data by a ring-configured cadmium-zinc-telluride (CZT) gamma camera and its agreement with HMR determined from [<sup>123</sup>I]mIBG planar images by an Anger gamma camera, in the assessment of myocardial sympathetic innervation.</div></div><div><h3>Methods</h3><div>A total of 105 study participants (suspected idiopathic rapid-eye-movement sleep behavior disorder n = 55, early-stage Parkinson's Disease n = 36, and healthy controls n = 14) who were referred for [<sup>123</sup>I]mIBG myocardial scintigraphy were included, in addition to eight phantom experiments simulating a range of HMR. HMR was determined from planar and reprojected planar images acquired with an Anger gamma camera and a ring-configured CZT gamma camera, respectively, for all study participants and phantom experiments. Agreement in HMR between the two imaging methods was analyzed in Bland-Altman plots. Intra- and interobserver variability was evaluated for both imaging methods in a subset of images.</div></div><div><h3>Results</h3><div>The agreement between planar and reprojected planar images was good, with a mean difference in HMR of 0.11 (95% limits of agreement −0.16 to 0.38) for the study participants. Intra- and interobserver variability was low and comparable for both imaging methods. Results from the phantom experiments were consistent with those from the study participants.</div></div><div><h3>Conclusions</h3><div>Determining HMR from reprojected [<sup>123</sup>I]mIBG myocardial scintigraphy planar images acquired with a ring-configured CZT gamma camera is feasible and shows good agreement with HMR determined from planar images by a conventional Anger gamma camera.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"56 ","pages":"Article 102574"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-02-28DOI: 10.1016/j.nuclcard.2026.102655
Marcelo F. Di Carli MD, MASNC
{"title":"SPECT's next act in nuclear cardiology","authors":"Marcelo F. Di Carli MD, MASNC","doi":"10.1016/j.nuclcard.2026.102655","DOIUrl":"10.1016/j.nuclcard.2026.102655","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"56 ","pages":"Article 102655"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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