Letter from the editors

Article Outline

• Copyright

The introduction and rapid development of cardiovascular nuclear medicine has been truly impressive. During the past several years, it began to appear as if cardiovascular nuclear medicine had peaked and the technique was being used mainly in clinical practice with very few truly significant innovations. The methodology has been applied extensively and its place in the management of patients with suspected coronary artery disease appears to be well defined, as described in the article on the use of nuclear cardiology in clinical decision making by Drs Berman and Hachamovitch. Even with this significant amount of accumulated clinical knowledge, there still remain some remarkable weak points in the understanding of myocardial perfusion imaging. This is apparent when one considers its application to special populations such as women, diabetics, and patients with heart failure, as reviewed by Dr Jennifer Mieres and colleagues. Even though it may appear that most of the investigational work on perfusion imaging has been done, there still is room for more. Another related area that will profit from further refinement is the application of attenuation correction to myocardial perfusion studies as described in detail by Drs Timothy Bateman and S. James Cullom, who suggest that a significantly more reliable and useful study can be obtained with proper attenuation correction.

A more evolutional area is the increasing utilization of PET for studies of the heart. Drs Travin and Bergmann review the evaluation of myocardial viability where the use of PET has become critical. This qualifies as perhaps a gold standard for the determination of viable and potentially viable myocardium as well as the definition of stunned, hibernating, and dead heart muscle. PET has an even more extensive role to play in perfusion imaging of patients who are not suitable for routine SPECT imaging because of problems related to body habitus. Like all of Nuclear Medicine, whenever it appears that a field is leveling off in its growth and applicability, some new technique is introduced. This axiom is exemplified by the article from Drs Sinusas and Dobrucki who review some of the developments that are occurring in cardiovascular molecular imaging. This article will leave the reader with the clear impression that, 10 years from now, nuclear cardiology techniques to evaluate myocardial perfusion and viability will have an entirely different physiologic basis. We will have gained specificity and sensitivity. It seems likely that the role of nuclear medicine in cardiac evaluation will continue to evolve over the next decade and assume an even more important role than the one in which it has already achieved.