SPECT vs. PET in cardiac innervation imaging: clash of the titans

Rudolf A. Werner, Xinyu Chen, Mitsuru Hirano, Steven P. Rowe, Constantin Lapa, Mehrbod S. Javadi, Takahiro Higuchi

Research output: Contribution to journalReview articlepeer-review

18 Citations (Scopus)


Purpose: We aim to provide an overview of the conventional single photon emission computed tomography (SPECT) and emerging positron emission tomography (PET) catecholamine analogue tracers for assessing myocardial nerve integrity, in particular focusing on 18F-labeled tracers. Results: Increasingly, the cardiac sympathetic nervous system (SNS) is being studied by non-invasive molecular imaging approaches. Forming the backbone of myocardial SNS imaging, the norepinephrine (NE) transporter at the sympathetic nerve terminal plays a crucial role for visualizing denervated myocardium: in particular, the single-photon-emitting NE analogue 123I-meta-Iodobenzylguanidine (123I-mIBG) has demonstrated favorable results in the identification of patients at a high risk for cardiac death. However, cardiac neuronal PET agents offer several advantages including improved spatio-temporal resolution and intrinsic quantifiability. Compared to their 11C-labeled counterparts with a short half-life (20.4 min), novel 18F-labeled PET imaging agents to assess myocardial nerve integrity have the potential to revolutionize the field of SNS molecular imaging. The longer half-life of 18F (109.8 min) allows for more flexibility in the study design and delivery from central cyclotron facilities to smaller hospitals may lead to further cost reduction. A great deal of progress has been made by the first in-human studies of such 18F-labeled SNS imaging agents. Moreover, dedicated animal platforms open avenues for further insights into the handling of radiolabeled catecholamine analogues at the sympathetic nerve terminal. Conclusions: 18F-labeled imaging agents demonstrate key properties for mapping cardiac sympathetic nerve integrity and might outperform current SPECT-based or 11C-labeled tracers in the long run.

Original languageEnglish
Pages (from-to)293-303
Number of pages11
JournalClinical and Translational Imaging
Issue number4
Publication statusPublished - Aug 1 2018
Externally publishedYes


  • C-hydroxyephedrine
  • F-LMI1195
  • I-metaiodobenzylguanidine
  • Positron emission tomography
  • Single photon emission computed tomography
  • Sympathetic nerve

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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