Table 3.
Overview of clinically used nuclear medicine methods for monitoring for the occurrence of cardiotoxicity
| Modality | Parameters | Advantages | Disadvantages |
|---|---|---|---|
| ERNA |
-Ventricular volumes -Ejection fractions -Systolic and diastolic function -Wall motion -Phase analysis |
-Highly standardized -Excellent reproducibility -Observer independent -Virtually no restrictions regarding patient selection (e.g., obesity, cardiac devices) -Evaluation of both right and left ventricles |
-No assessment of myocardial perfusion |
| MPI (SPECT) |
-Left ventricular volumes -Left ventricular ejection fraction -Systolic and diastolic function -Wall motion -Phase analysis -Myocardial perfusion (qualitatively) |
-Highly standardized -Good reproducibility -Virtually no restrictions regarding patient selection (e.g., obesity, cardiac devices) |
-No assessment of right ventricle |
| MPI (PET) |
-Ventricular volumes -Ejection fractions -Systolic and diastolic function -Wall motion -Myocardial perfusion (quantitatively) |
-Highly standardized -Good reproducibility -Quantification (MBF, MFR) -Assessment of epicardial and microvascular disease -Detection of even subtle changes |
-Limited availability -Relatively expensive |
| Innervation imaging (e.g., MIBG SPECT, HED PET) |
-Distribution and integrity of sympathetic innervation -Sympathetic tone (tracer washout) -Novel tracers, e.g., receptor density |
-Changes in innervation appear before structural or functional changes of the heart | -Limited data |
| Glucose metabolism (2-[18F]FDG PET) of the myocardium |
-Regional changes in 2-[18F]FDG uptake -Quantitative parameters (SUV) |
-Changes appear before structural or functional changes of the heart -Patients often receive the examination anyways for their oncological disease |
-Many influential factors on 2-[18F]FDG uptake (not specific for cardiotoxicity) -Limited data |
ERNA equilibrium radionuclide angiography, 2-[18F]FDG 18-fluoro-deoxyglucose, HED [11C]C-metahydroxyephedrine, MBF myocardial blood flow, MFR myocardial flow reserve, MIBG [123I]-metaiodobenzylguanidine, MPI myocardial perfusion imaging, PET positron emission tomography, SPECT single-photon emission computed tomography