American Society of Nuclear Cardiology (ASNC) President Mouaz Al-Mallah, MD, chair of cardiovascular PET and associate director of nuclear cardiology at Houston Methodist DeBakey Heart and Vascular Center, and ASNC President-elect Larry Phillips, MD, director of nuclear cardiology at NYU Langone Health, spoke with Cardiovascular Business about key trends in cardiac molecular imaging at ACC.23 in New Orleans.
New technology and applications for nuclear cardiology
"It is a very exciting and important time for nuclear cardiology because we are seeing more adoption of cardiac PET and newer technologies, including myocardial blood flow," Al-Mallah explained. "We are also seeing an increased usage among our members to measure atherosclerosis plaque burden in the coronary arteries. Nuclear cardiology also is not just a single application modality now, and have moved beyond perfusion to other applications to look at myocardial inflammation and infection of devices."
Other new applications for nuclear cardiology include imaging for cardiac amyloidosis and sarcoidosis. Al-Mallah explained these new imaging uses have really helped transform nuclear cardiology imaging departments over the last few years.
"One exciting thing is as we move beyond perfusion imaging and we start looking at other disease states that nuclear cardiology is able to help diagnose and help with treatment monitoring, that does have inherent growth. As we expand these through the nuclear cardiology community, we are going to see a rise in that type of volume," Phillips explained.
These new areas of growth will be important for nuclear cardiology, because procedure volume has been slowly decreasing over the past decade.
Declining numbers of exams in nuclear cardiology
The number of nuclear imaging exams overall has been decreasing over the past decade as other tests such as cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have seen increased usage. This is in part due to wider access to these modalities and new technologies that have improved CT to lower radiation dose below that of nuclear scans and added additional information to help answer clinical questions.
However, Al-Mallah said there are still are clear indications for specific patients were nuclear imaging is the preferred imaging modality to answer clinical questions the other imaging modalities cannot. Nuclear imaging technology also has improved and added additional information and value, including increasing use of CT calcium scoring on SPECT-CT and PET-CT scanners, and new methods to more accurately quantify blood flow in heart tissue to better measure the level of disease and the reversibility of ischemia if the patient is revascularized.
"Other modalities may not be able to offer the same level of accuracy in these areas that nuclear imaging can," Al-Mallah said.
Newer nuclear technologies such as PET are able to offer higher-quality imaging and the ability to image very obese patients, something other modalities may have issues doing in large patients. In CT, more obese patients can be imaged, but it requires higher levels of radiation, he said.
"It is not about increasing my pie or another pie; we want our members and referring doctors to use the most appropriate test. We don't want people or societies to say 'my modality first.' We want to put the patient first, in the center. I would not shy away from ordering another test that is most appropriate for the right patient and the right indication," Al-Mallah said. "There is no one-stop-shop imaging modality."
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com