Rationale and radiopharmaceuticals for myocardial imaging

Static radionuclide imaging procedures are now available for evaluating regional myocardial perfusion and for detecting acute myocardial infarction. Thallium-201, a radiopharmaceutical that possesses many of the characteristics of potassium analogues, at present is receiving the greatest attention as a regional blood flow indicator. Ischemic lesions appear as areas of decreased tracer uptake. Unfortunately, this agent is expensive, is in limited supply, and has a photopeak that is low for optimum imaging. Positive infarct images can be obtained with various Technetium-99m chelates. Pyrophosphate appears to be the best of the technetium compounds studied to date, although the mechanism of uptake of the chelates has not yet been fully elucidated. Therefore, quantitative measurements of infarct size are not justified. As perfusion imaging and infarct imaging provide useful, complementary data, a dual tracer approach to evaluating patients with suspected coronary artery disease and/or myocardial infarction, is probably justifiable.