New horizons in cardiac innervation imaging: Introduction of novel ¹⁸F-labeled PET tracers

Cardiac sympathetic nervous activity can be uniquely visualized by non-invasive radionuclide imaging techniques due to the fast growing and widespread application of nuclear cardiology in the last few years. The norepinephrine analogue ¹²³I-meta-iodobenzylguanidine (¹²³I-MIBG) is a single photon emission computed tomography (SPECT) tracer for the clinical implementation of sympathetic nervous imaging for both diagnosis and prognosis of heart failure. Meanwhile, positron emission tomography (PET) imaging has become increasingly attractive because of its higher spatial and temporal resolution compared to SPECT, which allows regional functional and dynamic kinetic analysis. Nevertheless, wider use of cardiac sympathetic nervous PET imaging is still limited mainly due to the demand of costly onsite cyclotrons, which are required for the production of conventional ¹¹C-labeled (radiological half-life, 20 min) PET tracers. Most recently, more promising ¹⁸F-labeled (half-life, 110 min) PET radiopharmaceuticals targeting sympathetic nervous system have been introduced. These tracers optimize PET imaging and, by using delivery networks, cost less to produce. In this article, the latest advances of sympathetic nervous imaging using ¹⁸F-labeled radiotracers along with their possible applications are reviewed.