An ASNC 20th Anniversary Article Major Achievements in Nuclear Cardiology

Journal of Nuclear Cardiology

, Volume 20, Issue 1, pp 128-143

First online:

Cardiac autonomic imaging with SPECT tracers

  • Mark I. TravinAffiliated withDivision of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine Email author 


Radionuclide cardiac imaging has potential to assess underlying molecular, electrophysiologic, and pathophysiologic processes of cardiac disease. An area of current interest is cardiac autonomic innervation imaging with a radiotracer such as 123I-meta-iodobenzylguanidine (123I-mIBG), a norepinephrine analogue. Cardiac 123I-mIBG uptake can be assessed by planar and SPECT techniques, involving determination of global uptake by a heart-to-mediastinal ratio, tracer washout between early and delayed images, and focal defects on tomographic images. Cardiac 123I-mIBG findings have consistently been shown to correlate strongly with heart failure severity, pre-disposition to cardiac arrhythmias, and poor prognosis independent of conventional clinical, laboratory, and image parameters. 123I-mIBG imaging promises to help monitor a patient’s clinical course and response to therapy, showing potential to help select patients for an ICD and other advanced therapies better than current methods. Autonomic imaging also appears to help diagnose ischemic heart disease and identify higher risk, as well as risk-stratify patients with diabetes. Although more investigations in larger populations are needed to strengthen prior findings and influence modifications of clinical guidelines, cardiac 123I-mIBG imaging shows promise as an emerging technique for recognizing and following potentially life-threatening conditions, as well as improving our understanding of the pathophysiology of various diseases.


MIBG imaging iodine-123 molecular imaging autonomic imaging