Myocardial scintigraphy--25 years after start.

The development of myocardial scintigraphy (MS) reflects the clinical success of a representative procedure in nuclear medicine. Radiopharmaceuticals for visualizing vital and damaged myocardium and techniques (planar-qualitative, planar-quantitative, SPECT-qualitative-quantitative with comparative sensitivities) are briefly reviewed with the main focus on their clinical application in coronary (CHD) and noncoronary heart disease, where recent literature from the United States and Europe is considered. The limited value of MS for screening of CHD is outlined and its present and future role in detecting asymptomatic (silent) ischemia/infarction and symptomatic patients at professional risk is stressed. The present state of MS in coronary heart disease is discussed for single and multivessel disease, previous infarction, and risk stratification (myocardial washout, pulmonary uptake, ischemic dilation, absent heart sign), reflecting the importance of the procedure in exercise-induced ischemia as well as in ischemia at rest for prognostication of the natural and therapeutic course, i.e., therapy control (angioplasty, bypass, lysis, cardiac drugs). More marginal but upcoming clinical indications are mentioned, such as progressive systemic sclerosis, cardiac transplantation, pediatric cardiology, and problems of nephrology/urology. The "normal" values and the impact of digital radiology and of contrast cardiography are touched upon. Preliminary cases with 111In-antimyosin and 99mTc-Isonitriles are presented including correlative results between global ejection fraction determination according to gated 99mTc-isonitrile and conventional 99mTc-erythrocyte ventriculogram (r = 0.75; n = 10).