Quantitative nuclear cardiology using SPECT : evaluation of perfusion, function and innervation

Abstract

The application of nuclear imaging for non-invasive assessment of cardiovascular diseases is well established. Although the visual assessment of myocardial perfusion will remain the mainstay for some time, the field is changing. Advancements in device technology, processing techniques and radiopharmaceuticals have shifted the field beyond the assessment of perfusion alone towards an integrated evaluation of perfusion, function and innervation. Quantitative nuclear cardiology is becoming ever more important in a clinical setting. And, while the improvements in automated quantification have increased the diagnostic accuracy, there are various factors that may induce inaccuracies. The dependence of functional MPS indices on, for example, the software package or the injection-acquisition time interval, are indistinct. Also the meaning of recently introduced functional parameters and their relation to other indices remain unclear. For innervation imaging, the lack of standardization regarding acquisition and processing still affect the clinical applicability of this technology. All these ambiguities of SPECT-based quantification are addressed in this thesis.