Diagnostic and Prognostic Impact of Nuclear Medicine in the Management of Acute Chest Pain

Life-threatening and prevalent causes of acute chest pain can be ruled out by nuclear medicine techniques. Among them acute coronary syndromes (ACS), acute myocardial infarction (AMI) or suspected pulmonary embolism (PE) are the main indications for the use of nuclear medicine techniques in patients presenting with chest pain to the emergency department (ED). Myocardial perfusion imaging (MPI) using nuclear techniques is a well established diagnostic tool in the management of patients with ACS or AMI providing non-invasively information about perfusion and function. Single photon emission computed tomography (SPECT) is routinely applied for MPI allowing the characterization of localization, extent and severity of perfusion abnormalities. SPECT MPI is accurate and feasible in the clinical settings of patients presenting with chest pain. Pulmonary embolism is a common clinical disorder that is associated with high morbidity and mortality if untreated. Because of the unspecific symptoms commonly observed with the disease confirmation or exclusion of PE needs to be done in many cases admitted to ED. Various diagnostic strategies are available to confirm or rule out PE. Discordance between clinical probability and the results of diagnostic tests require imaging studies. Both lung perfusion and ventilation scintigraphy are safe, feasible and reliable methods enabling to exclude PE in patients with a low clinical probability. In summary, the documented prognostic value of scintigraphic parameters is of clinical importance to guide decision-making in the patient with acute chest pain. Additionally, the cost-effectiveness of nuclear medicine techniques in the work-up of patients with chest pain has been demonstrated.