Nuclear Cardiology: Basic and Advanced Concepts in Clinical Practice

Foreword
Editors’ Personal Note
Preface
Contents
Contributors
Chapter 1: Cardiac PET Procedure: Perfusion, Coronary Flow, Viability, Inflammation, and PET/MR
	PET (Positron Emission Tomography) Procedure
	Perfusion
		Positron Emission Tomography Myocardial Perfusion Imaging
			Radiotracers
			PET Acquisition
			PET Imaging Protocols
			Patient Preparation and Protocols
			Patient Positioning
			Dipyridamole Stress Test Procedure
			Adenosine Stress Test Procedure
			Image Processing
			18Fluorine-Based Perfusion Radiotracers
			PET Myocardial Perfusion (Relative Perfusion Images)
			Left Ventricular Function with PET
			PET Perfusion Image Interpretation
			Myocardial Blood Flow (MBF) and Coronary Flow Reserve (CFR) Quantification
			Coronary Circulation/Coronary Microcirculation/Coronary Reserve
			Absolute Quantification of Myocardial Blood Flow (MBF) and Determination of Coronary Flow Reserve (CFR)
			Integrating the Perfusion Images, Functional Images, and Quantitative Parameters: Interpretation
			Dosimetry
	Myocardial Viability with PET
		Glucose Metabolism
		18F-FDG-PET Myocardial Viability Protocol
		Acquisition Parameters [29]
		Interpretation Criteria
		Fatty Acid Metabolism and Myocardial Oxygen Consumption
		Mitochondrial Membrane Potential
		Microvascular Dysfunction in the Context of Myocardial Viability
	Cardiovascular Inflammation
		Glucose Metabolism
		Patient Preparation in Order to Avoid 18F-FDG Physiologic Myocardial Uptake
			Dietary Approaches
		Important Considerations for Image Interpretation
		Imaging Protocol [29]
		Interpretation (General)
		Infective Endocarditis (More Information in Chap. 26: Nuclear Imaging in the Management of Infective Endocarditis by Jadvar Hossein)
			Prosthetic Valve Endocarditis
			Interpretation of 18F-FDG-PET/CT Images
		Native Valve Endocarditis
		Cardiac Implantable Electronic Device (CIED) Infection
			Classification
			Interpretation
		Graft Infection
		Cardiac Sarcoidosis
			Diagnostic by PET
	Hybrid Magnetic Resonance Imaging and Positron Emission Tomography (PET/MR)
		Attenuation Correction in PET/MR
		Motion Correction
		Image Post-processing, Visualization, and Quantification
		Cautions for Performing Cardiac PET/MRI Examination Safely
		Potential Clinical Indications for Cardiac PET/MRI
			PET/MR in Cardiac Sarcoidosis (CS)
			PET/MR in Ischemic Cardiomyopathy
	References
Chapter 2: SPECT Procedures
	Introduction
	Functional Tests
		Exercise Test
			Contraindication [4]
				Absolute
				Relative
			Limitations
			Procedure
			Indications for Early Completion of the Exercise
		Pharmacologic Evidence
			Vasodilators
				Adenosine
					Hemodynamic Effects: What to Expect from Adenosine Infusion
					Indications
					Contraindications
						Absolute
						Relative
					Preparation for Examination and Procedures
					•	 Reversion of Adverse Effects
					Combination of Low-Level Exercise with Adenosine
				Regadenoson
					Preparation for Examination and Procedures
					Combination of Low-Level Exercise with Regadenoson
				Dipyridamole
					Side Effects: What to Expect from Dipyridamole Infusion
					Preparation for Examination and Procedures
					Combination of Low-Level Exercise with Dipyridamole
					Pharmacological Stress with Synthetic Catecholamines
					Side Effects: What to Expect from Dobutamine Infusion
					Indications: When to Request Dobutamine
					Contraindications
						Absolute
						Relative
					Preparation for Examination and Procedures
					Special Populations for Pharmacologic Test
					Radiotracers and Protocols
					Radiopharmaceuticals
						99mTc-sestamibi
						Thallium-201
					New Perspectives
					CZT Cameras
						Cardiac Scintigraphy with 123I-MIBG
							Mechanism of Action
							Indications
							Procedures
							Dose
							Adverse Reactions
							Performing the Images
					Calculating HMR and WR
	References
Chapter 3: Evaluation of Myocardial Blood Flow and Myocardial Flow Reserve by Radionuclide Imaging
	PET/CT
		Radiopharmaceuticals
		15Oxygen-Water
		13N-Ammonia
		Rubidium-82
	Imaging Procedure
		Patient
	Clinical Application
		Future Perspectives
	Conclusion
	References
Chapter 4: Radiation Protection and Exposure in Nuclear Cardiology
	Radiation in Our Routine
	Ionizing Radiation
	Main Types of Ionizing Radiation
	Interaction of Ionizing Radiation with Matter
	Dose Quantities in Radiological Protection
		Absorbed Dose
	Equivalent Dose to Tissue or Organ T
	Effective Dose
	Radiation Applications in Medicine
	Nuclear Medicine
	Nuclear Cardiology
	Gamma Camera
	Positron Emission Tomography (PET)
	Radiation Protection
	Patient’s Radiation Protection
	Occupational Radiation Protection
	References
Chapter 5: Non-nuclear Cardiac Imaging Modalities: CT and MRI
	Advantage and Assessment of Cardiovascular Structure and Function with CMR
	Ischemic Heart Disease and Myocardial Infarction/Scar
	Non-ischemic Cardiomyopathies
	Hypertrophic Cardiomyopathy
	Amyloidosis
	Cardiac Sarcoidosis
	Iron-Overload Cardiomyopathy
	Myocarditis
	Chagas Disease
	Dilated Cardiomyopathy
	Valve Disease
	Cardiac Masses and Tumors
	Pericardial Disease
	Congenital Heart Disease
	CMR Safety
	Cardiac Computed Tomography (CCT)
	Coronary Artery Calcium Scoring
	Coronary Computed Tomographic Angiography
	Beyond Coronary Stenosis
	Functional vs. Anatomic Approach – SCOT-HEART and PROMISE
	How Will the ISCHEMIA Trial Affect the Future Application of CCTA?
	References
Chapter 6: Coronary Physiology: From Basic Concepts to FFR and iFR
	Introduction
	Fundamentals of the Coronary Pressure-Flow Relationship
	(Patho)Physiological Processes in the Presence of a Stenosis
	Introduction of Coronary Physiology in Clinical Practice: Basic Principles, Validation, and Implementation
		Fractional Flow Reserve in Stenosis Assessment
		Coronary Flow in Stenosis Assessment
		Improving Hemodynamic Stenosis Assessment: Combining Pressure and Flow
		New Kid on the Block: The Introduction of Instantaneous Wave-Free Ratio in Stenosis Assessment
			Clinical Case: How to Deal with iFR-FFR Discordance?
			Clinical Case: How to Deal with iFR-FFR Discordance?
			Clinical Implications for the Future
	Conclusion
	References
Chapter 7: Coronary Artery Calcium and Hybrid Imaging in Ischemic Heart Disease
	Introduction
	Part I: Coronary Artery Calcium Score
		Diagnostic Applications of CAC Score with MPI
		Prognostic Applications of CAC Score Along with MPI
	Part II: Hybrid Cardiac Imaging – SPECT/CT
		CT for Myocardial Perfusion Imaging: Attenuation Correction
		Integration of MPI with CCTA
	Part III: Hybrid Imaging – PET/CT
		Instrumentation and Technical Aspects of Hybrid Imaging
		Clinical Applications of Hybrid PET/CT
		Risk Stratification Derived from Hybrid PET/CT
		Radiation Exposure Derived from Hybrid Imaging
		Indications and Appropriate Use Criteria for Hybrid Imaging PET/CT
	Part IV: Hybrid Imaging with Cardiac PET/MRI
	Conclusion
	References
Chapter 8: Coronary Blood Flow Reserve and Myocardial Ischemia
	Introduction
	Understanding the Basic Concepts of Coronary Physiology
	Ischemia-Stenosis Relationship
	Rationale and Clinical Value of MBF Quantification
		MBF Quantification Prognostic Value in Patients with CAD
		MBF Quantification Prognostic Value in Patients with Nonischemic Cardiomyopathy
		MBF Quantification in a Specific Population: Heart Transplant
		Clinical Value of MBF Quantification with SPECT
	Understanding the Vasodilators Used in Clinical Practice
	PET Instrumentation and Protocol
	SPECT Instrumentation and Protocol
	Nomenclature and Interpretation
	Future Direction
	Conclusion
	References
Chapter 9: Nuclear Cardiology and Coronavirus Disease 2019 (COVID-19) Pandemic
	Coronavirus Disease 2019
	Coronavirus Disease 2019 and Cardiovascular Manifestations
	Nuclear Cardiology Role in Coronavirus Disease 2019
	Best Practices in Nuclear Cardiology During the Coronavirus Disease 2019 Pandemic
	References
Chapter 10: Nuclear Imaging in Stable Ischemic Coronary Disease
	Introduction
		Nuclear Medicine Procedures in Cardiology
		Perfusion Index Considerations
		Pharmacologicallly Induced Stress
	Part 3: Clinical Aspects
		Clinical Applications of Myocardial Perfusion Scintigraphy and Positron Emission Tomography
			Diagnosis of Coronary Artery Disease
			Prognostic Assessment and Risk Stratification
			Functional Assessment of Known Anatomical Lesions
			Assessment After Myocardial Revascularization Surgery
			Evaluation After Percutaneous Revascularization
			Therapeutic Monitoring
			Evaluation in Acute Coronary Syndromes
			Myocardial Viability Investigation
			18F-Fluorodeoxyglucose with Positron Emission Tomography
	Nuclear Medicine in Special Populations
		Multivessel Patients
		Diabetic Patients
		Women
		Elderly Patients
		Patients with Chronic Renal Failure
		Athletes
	Extent Determination of Ischemia and Therapeutic Determination
	Part 4: Future Prospects
	Part 5: Conclusion
	References
Chapter 11: Nuclear Imaging in Acute Coronary Syndromes
	Introduction
	Acute Chest Pain in Patients Received at the Emergency Department with Normal or Nondiagnostic ECG
		Role of Nuclear Cardiology Techniques in the Assessment of Patients with Acute Chest Pain
	Non-ST Segment Elevation Acute Coronary Syndromes
	ST-Segment Elevation Myocardial Infarction (STEMI)
		To Assess Myocardium at Risk, Salvaged Area, and Infarct Size
		To Detect Ischemia in the Non-IRA Territories After a Primary PCI in a Patient with Multivessel Disease
			Approach of the Guidelines
		To Risk Stratify for Sudden Cardiac Death
	Takotsubo Syndrome
		Diagnosis
			Electrocardiogram
			Echocardiogram
			Cardiac Magnetic Resonance
			Nuclear Imaging
			Coronary Angiography and Left Ventriculography
	References
Chapter 12: Nuclear Techniques Before and After Coronary Revascularization
	Introduction
	Strengths of Nuclear Cardiology
	Nuclear Cardiology Techniques Before Revascularization
	Nuclear Cardiology Techniques After Revascularization
	Current Appropriate Use Criteria of MPI
	MPI Versus CTA to Guide Revascularization
	MPI Versus CTA to Detect Restenosis Post Intervention
	Conclusions
	References
Chapter 13: Physiologic and/or Anatomic Assessment of CAD: Patient-Centered Approach
	Introduction
	Technologies to Evaluate CHD in a Contemporary Practice of Medicine
	Conclusion
	References
Chapter 14: Evidence-Based and Nuclear Cardiology
	Chronic Coronary Syndromes
	Acute Coronary Syndromes
	Myocardial Viability
	Amyloidosis, Sarcoidosis, Infection, and Neuronal Imaging
		Amyloidosis
		Infective Endocarditis
		Sarcoidosis
		Neuronal Imaging
	Conclusion
	References
Chapter 15: Pathophysiology, Diagnosis, and Management of Heart Failure
	Introduction
	Pathophysiology
		Ventricular Mechanics
		Cardiac Remodeling
		Reverse Remodeling
		Microstructural Changes
		Interstitial Fibrosis
		Macrostructural Changes
		Activation of the Neurohumoral System
		Natriuretic Peptides
		Immunoinflammatory Activation
		Mitochondria
	Diagnosis
	Treatment
	References
Chapter 16: PET and SPECT Evaluation of Viable Dysfunctional Myocardium
	Introduction
	Viability Concepts
	Patient Selection for a Viability Study
	Guidelines for Viability Imaging in Heart Failure
	SPECT and PET: Radiopharmaceuticals and Protocols
		SPECT
			Thallium-201
			Technetium-99m-Labelled Agents
		FDG PET
	Other Modalities to Assess Viability
	Clinical Evidence for Viability Testing
	New Studies: IMAGE-HF; Role of Neurohormonal Imaging; PAREPET; and Application in Chronic Total Occlusion
	Conclusion
	References
Chapter 17: Bone Tracers for the Diagnosis of Cardiac Amyloidosis
	What Is Amyloidosis?
	When Should I Suspect of Cardiac Amyloidosis (CA)
		The Electrocardiogram
		Biomarkers
		The Echocardiogram
		Magnetic Resonance Imaging (MRI)
	Most Common Types of CA
		Transthyretin (TTR) Amyloidosis
			Mutant Transthyretin (TTRm)
			Wild Transthyretin (TTRw)
		Light Chain Amyloidosis (AL)
	Bone Tracer Scintigraphy
		Bone Scintigraphy Protocols for CA
		Suggested Diagnostic Sequence
	Other Nuclear Medicine Techniques for CA Evaluation
	Final Considerations
	References
Chapter 18: Adrenergic Nervous System Imaging in HF Management
	Introduction
	Physiology of Myocardial Innervation
	Myocardial Kinetics of mIBG
	Physiological and Pathophysiological Distribution of mIBG in the Myocardium
	Technique and Radiopharmaceutical
	Prognostic Value of Cardiac123I-mIBG in Risk-Stratifying HF Patients
	PET Tracers in HF Assessment
	Conclusion
	References
Chapter 19: Takotsubo Cardiomyopathy and Nuclear Imaging
	Definition and Epidemiology
	Pathophysiology
	Clinical Presentation
	Types of Takotsubo Cardiomyopathy
	Diagnostic Criteria
	Role of Nuclear Cardiology Using 123I-MIBG
	Conclusion
	References
Chapter 20: PET and SPECT in Inflammatory Diseases: Sarcoidosis, Myocarditis, and Vasculitis
	Sarcoidosis
		Introduction
		Clinical Aspects
		Imaging in CS
		PET and Single Photon Emission Tomography (SPECT) in CS Evaluation
			Diagnosis
		Other Radiopharmaceuticals (Beyond FDG)
		Follow-Up/Treatment Evaluation
		Diagnostic Accuracy
		Prognostic Information
	Myocarditis
		Introduction
		Epidemiology
		Etiology
			The Virus Importance
			Noninfectious Causes
			Immune Checkpoint Inhibitors (ICI)-Related Myocarditis
		Diagnosis
		Nuclear Medicine
			Gallium-67 Citrate
		Other SPECT Radiotracers
			Monoclonal Antibodies
			Imaging Apoptosis
		Myocardial Perfusion Imaging
		PET–CT (Cardiac 18F-FDG PET Imaging)
			Background
			Patient Preparation for Cardiac Inflammation FDG Imaging
			Role of FDG PET–CT in Assessing Myocarditis
		Cardiac MRI
			Background
		Integrated PET–MR
		Key Points for Cardiac PET–MR
			Reduced Radiation Exposure
			Motion and Partial Volume Correction
			Soft Tissue Contrast
		Invited Perspectives: PET–CT/PET–MR with Other Radiotracers
			Gallium-68 Tracers
			Carbon-11 Tracers
	FDG PET–CT in Vasculitis and Polymyalgia Rheumatica
		Introduction
		Effect of Glucocorticoids in FDG Vascular Uptake
		Interpretation Criteria
		Diagnostic Accuracy
		Disease Activity
		FDG PET in Medium- and Small-Sized Vessel Vasculitis
	References
Chapter 21: Cardiovascular Risk Stratification Prior to Non-cardiac Surgery
	General Issues
	Assessing the Surgery Timing
	Assessing the Surgery Risk
	Assessing the Clinical Cardiovascular Risk
	General Methods (Non-stress Imaging) for Non-invasive Perioperative Cardiovascular Risk Assessment
	Radionuclide Stress Testing, SPECT MPI to Assess Perioperative Cardiovascular Risk and Some Technical Issues
		MPI Diagnostic and Prognostic Value
		Technical Issues
	Safety of Radionuclide Non-invasive Stress Testing
	Radionuclide Stress Testing in Special or Vulnerable Population
	Other Images Available for Non-invasive Assessment of Cardiovascular Risk
	Role of Images in Guidelines for Cardiovascular Perioperative Risk Assessment
	Conclusions
	References
Chapter 22: Exercise and Pharmacologic Stress Testing
	Introduction
	Physiology of Physical Stress
	Cardiopulmonary System
	Exercise Stress Test
	Exercise Stress Test Protocol
	Contraindications to Stress Testing
	Indications for Termination of Exercise Stress Testing
		Absolute
		Relative
	Preparation for the Exercise Stress Testing
	Electrocardiographic Leads for Exercise Stress Testing
	Basal Electrocardiography
	Stress Protocols
	Protocols for Treadmill Test
		Ramp Protocol
		Bruce Protocol
		Radiotracer Injection
		Image Protocols
	Normal Exercise Electrocardiographic Response
	Diagnostic Value of Exercise Stress Testing
	Stress Testing Interpretation
	Localization of Ischemia by ECG Patterns
		ST Elevation Due to Transmural Ischemia
			ST Depression in V1
			Localization of Proximal or Distal LAD
	Pharmacological Stress Testing
	Vasodilators
	Dipyridamole
	Indications for Adenosine and Dipyridamole
	Contraindications for Adenosine and Dipyridamole
	Drugs That Promote Increased Oxygen Uptake
	Dobutamine Indications
	Dobutamine Contraindications
	Combination of Low-Level Exercise with Dipyridamole Infusion
	Hybrid Protocols
	Anti-ischemic Effects of Medications
	New Agents
	Other Inotropic Drugs
	Assessment of Pre-test Probability (PTP) and Clinical Likelihood of Coronary Artery Disease
	Selecting Appropriate Testing
	Incremental Information Derived from Stress Testing Protocols
	Bibliography
Chapter 23: Evaluation of Ventricular Function by Nuclear Imaging
	Technical Aspects
		Imaging Methodology for Gated SPECT
		Blood Pool Methods
		Imaging Methodology for Gated Positron Emission Tomography (Gated PET)
	Clinical Applications
		Diagnostic Value of Gated SPECT Functional Assessment
		Prognostic Value of Functional Assessment
		Left Ventricular Ejection Fraction
		Transient Ischemic Dilation
		Ventricular Volumes
		Regional Wall Motion and Thickening
		Diastolic Dysfunction
		Prognostic Value of Gated PET MPI Functional Assessment
	Bibliography
Chapter 24: 123I-mIBG in the Risk Stratification of Sudden Cardiac Death in Chronic Heart Failure
	Chronic Heart Failure
	Cardiac Sympathetic Activity
	Cardiac 123I-mIBG Scintigraphy
		Planar 123I-mIBG Scintigraphy Acquisition and Analysis
		SPECT 123I-mIBG Scintigraphy Acquisition and Analysis
	Planar 123I-mIBG Scintigraphy as Predictor of Cardiac Morbidity and Mortality in CHF
	Planar 123I-mIBG Scintigraphy as Predictor of Arrhythmia in CHF
	123I-mIBG Cross-Calibration
	123I-mIBG SPECT as Predictor of Cardiac Morbidity and Mortality in CHF
	123I-mIBG SPECT as Predictor of Arrhythmia in CHF
	Risk Calculation with 123I-mIBG Scintigraphy
	Conclusion
	References
Chapter 25: Nuclear Image-Guided Methods for Cardiac Resynchronization Therapy
	Introduction to CRT
		Heart Failure
		What Is CRT?
		How to Evaluate CRT Outcomes?
	Nuclear Imaging to Guide CRT
		Myocardial Imaging Techniques
		Nuclear Image-Guided Approaches for CRT
	Nuclear Imaging to Detect Myocardial Viability
	Nuclear Imaging to Detect Mechanical Dyssynchrony
	Nuclear Imaging to Detect Wall Thickening
	Nuclear Imaging to Guide CRT Patient Selection
	Nuclear Imaging to Identify the Optimal LV Lead Position
	Nuclear Imaging to Guide LV Lead Placement
	Large Multicenter Nuclear Image-Guided Clinical Trials
	Application of Artificial Intelligence in Guiding CRT
	Challenges and Future of Nuclear Imaging to Guide CRT
	References
Chapter 26: Nuclear Imaging in the Management of Infective Endocarditis
	Introduction
	Radiolabeled Leukocyte Scintigraphy
	FDG PET/CT (Include Cardiac Prep)
	Comparison of Radiolabeled Leukocyte Scintigraphy and FDG PET/CT
	Systematic Review and Meta-Analysis
	Summary
	References
Chapter 27: PET and SPECT in the Evaluation of Cardiac Implantable Electronic Devices
	Introduction
		Heart Failure
		Cardiac Implantable Electronic Devices
			Devices for Rhythm Control
				Artificial Pacemaker
				Implantable Cardioverter Defibrillator (ICD)
			Devices to Support the Heart and Circulation
				Left Ventricular Assist Device (LVAD)
	Cardiac Device-Related Infection Imaging
		Overview
		Echocardiography
		Computed Tomography (CT)
		Magnetic Resonance Imaging (MRI)
		Nuclear Cardiology
			18F-Fluorodeoxyglucose (FDG) PET/CT
				Positron Emission Tomography (PET) Overview
				18F-fluorodeoxyglucose (FDG) PET/CT
				18F
				FDG (Fluorodeoxyglucose)
				18F-FDG PET/CT
				Administered Dose
				Dosimetry
				Patient Preparation
				Protocol
				Image Interpretation
				Statistics
			Radiolabeled Autologous White Blood Cells (WBCs)
				Patient Preparation
				Blood Sampling and Radiolabeling
				99mTc-Exametazime (HMPAO)-Labeled Leukocytes
					Administered Activity
					Dosimetry
				Indium-111-WBC
					Administered Activity
					Dosimetry
					Radiolabeled Autologous White Blood Cells’ Image Acquisition
					Radiolabeled Autologous White Blood Cells’ Image Interpretation
					Statistics
			Gallium-67 Citrate
				Radiopharmaceutical
				Administered Dose
				Dosimetry
				Patient Preparation
				Contraindications
				Image Acquisition
				Image Interpretation
	Cardiac Sympathetic Nervous System
		Adrenergic Cardiac Imaging
			123I-mIBG (I-123 Metaiodobenzylguanidine)
				Cardiac 123I-mIBG Indications
				Patient Preparation
				Radiotracer Administration
				Adverse Reactions
				Radiation Exposure
				Imaging Technique
				Heart-to-Mediastinum Ratio (HMR)
				Washout Rate
				Image Interpretation
				Risk Stratification/Prognosis
				Use of Cardiac Adrenergic Imaging to Guide Therapy
				Dual Cardiac Adrenergic/Perfusion Imaging
			Cardiac Autonomic Imaging with PET Tracers
				11C-hydroxy-ephedrine (HED)
					Procedure
					Image Interpretation and Clinical Use
	References
Chapter 28: The Clinical Aspects of Heart Damage by Chemotherapy and Radiotherapy
	Introduction
		Cancer Treatment History
		Epidemiology
		Cardio-oncology
	Clinical Cardiotoxicity Manifestations
		Ventricular Dysfunction and Heart Failure
		Hypertension
		Thromboembolic Disease
		Coronary Disease
		Cardiac Arrhythmias and Conduction Disorders
		Immune Checkpoint Inhibitor Injuries
		Pulmonary Hypertension
	Cardiovascular Injuries Secondary to Radiotherapy
	Conclusions
	References
Chapter 29: Nuclear Medicine Tools for Cardiac Damage Diagnosis in Oncology
	Introduction
	LVEF Evaluation (MUGA and Gated SEPCT)
	Specific Evaluations
		Cardiac Sympathetic Evaluation
			123I-mIBG scintigraphy
			PET Tracers
		Apoptosis and Necrosis
		HER2 Receptors
		Myocardial Perfusion and Blood Flow (SPECT and PET)
		Fat Acid Metabolism and Other Evaluations by PET
		Mitochondrial Function (99mTc-MIBI)
		Myocardial Metabolism and Inflammation (18FDG)
	Conclusions
	References
Chapter 30: Acute Coronary Syndrome Evaluation with Nuclear Medicine in the Emergency Setting
	Background
		Coronary Risk Stratification Tests
		Exercise Test
		Stress Echocardiogram
		Magnetic Resonance
		Computed Tomography
		Myocardial Perfusion Scintigraphy
		Acute Myocardial Perfusion Imaging
	Rest and Stress Myocardial Perfusion
	Positron Emission Tomography
		Algorithm for Acute Chest Pain Evaluation
	References
Chapter 31: Diagnosis of Pulmonary Embolism
	Introduction
	Imaging Studies in PE Diagnosis
		Accuracy of V/Q Scintigraphy and CTPA
	Clinical Indications of V/Q Scintigraphy
	Methodology of V/Q Scintigraphy
		Ventilation Phase
		Perfusion Phase
		Pediatric
		Pregnancy
	V/Q Scintigraphy Interpretation
	Future Perspectives and New Trends
	Conclusion
	References
Chapter 32: Deep Learning and Artificial Intelligence in Nuclear Cardiology
	Introduction
	How Images Can Be Transformed in Numbers?
	Artificial Neural Network (ANN)
	Other Machine Learning Algorithms
	Will Machine Learning Replace the Nuclear Cardiologist?
	AI Applications in Nuclear Cardiology
	Conclusions
	References
Chapter 33: Programmes of the International Atomic Energy Agency for Nuclear Cardiology and Quality Management
	Introduction
	Challenges Associated With the Introduction of Newer Technologies
	Diagnostic Efficacy and Cost-Effectiveness
	The Programme in Human Health of the IAEA to Support Nuclear Cardiology
	Human Resources Capacity Building
	Economic Evidence on the Use of Nuclear Cardiology
	Managing Quality in Nuclear Cardiology and Nuclear Medicine in General (IAEA QUANUM Programme)
	References
Index