Nuclear imaging in detection and monitoring of cardiotoxicity

Table 1 Radiotracer for cardiac nuclear imaging

Technique	Tracer	Action
SPECT
	99mTc-erythrocyte	Contractile function
	111In-antimyosin	Imaging necrosis/cell death
	123I-MIBG	Neuronal imaging(presynaptic uptake and storage)
	111In-Tz	Therapeutic target imaging
	99mTc-annessin V	Imaging necrosis/cell death
	123I-BMIPP	Fatty acid use
PET
	18F-FDG	Glucose metabolism
	Presynaptic tracers	Visualize inhibition of neurotransmission
	true catecholamines
	18F-6-fluorodopamine
	11C-epinephrine
	catecholamine analogs	False neurotransmitters
	11C-HED
	11C-phenylephrine
	18F-6-fluoro-metaraminol
	Postsynaptic tracers	Visualize transmission of sympathetic signal to target tissue
	11C-CGP12177
	11C-CGP12388
	11C-GB67

SPECT: Single photon emission computed tomography; PET: Positron emission tomography; HED: Hydroxyephedrine; FDG: Fluorodeoxyglucose;

¹²³I-BMIPP: ¹²³I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid.

Table 2 Techniques used for detection of anticancer therapy cardiomiopathy

Methods	Advantages	Limits
Echocardiography	Non-invasive Absence of adverse effects Analysis of systolic and diastolic function Tissue velocity imaging and strain imaging useful for early detection of subclinical alteration	Inter- and intra-observer variability Low sensitivity of EF assessment for early diagnosis
Magnetic resonance imaging	Accurate heart anatomic description Absence of radiation exposure Accurate and reproducible EF assessment Cardiac innervation assessment	Limited availability High costs Not applicable in patients with metallic device Low information about its role in the early detection
Multiple-gated acquisition scintigraphy	High sensitivity and specificity EF assessment No inter- and intra-observer variability	Low sensitivity of EF for early diagnosis Less information about diastolic function Radiation exposure
Positron emission tomography	Myocardial metabolic and perfusion evaluation	Limited availability

EF: Ejection fraction.