Das Positionspapier der Deutschen Gesellschaft für Nuklearmedizin (DGN) und der Deutschen Gesellschaft für Kardiologie (DGK) aktualisiert die gemeinsame Stellungnahme aus dem Jahr 2018. Es gibt einen Überblick über die Einsatzbereiche und den aktuellen Stellenwert der nuklearkardiologischen Bildgebung. Behandelt werden die Themenfelder chronisches Koronarsyndrom einschließlich der Vitalitätsdiagnostik und der besonderen Bedeutung der PET, Kardiomyopathien, kardiale Sarkoidose, Amyloidose, infektiöse Endokarditis und Entzündung kardialer Implantate.

Positron emission tomography (PET) with amyloid-binding tracers was shown to have high sensitivity for the detection of both transthyretin (ATTR) and light-chain (AL) cardiac amyloidosis (CA). Recent studies describe prognostic value of imaging biomarkers from bone scintigraphy and 18F-Florbetapir. The aim of this study was to evaluate the value of imaging biomarkers from 18F-Florbetaben PET, cardiac magnetic resonance (CMR), and echocardiography imaging for prediction of major adverse cardiac events (MACE) in comparison to serum biomarkers in patients with different types of CA. Patients who underwent cardiac 18F-Florbetaben PET/MRI were prospectively enrolled and received clinical follow-up for up to 36 months and MACE were reported (NCT07154381). Scans were reported by two blinded, nuclear medicine physicians. Imaging biomarkers including average retention index (RI), T1 mapping/ extracellular volume (ECV) and serological markers were estimated and their association with MACE free survival was analyzed. Twenty-one patients with confirmed CA were enrolled. MACEs were reported in 14 of 21 patients (66.7

This updated position paper from the German Society of Nuclear Medicine (DGN) and the German Cardiac Society (DGK) replaces the original statement from 2018. It gives an overview of the fields of application and the current value of nuclear cardiological imaging. The topics covered include chronic coronary syndrome, including viability diagnostics and the special value of positron emission tomography (PET), cardiomyopathies, cardiac sarcoidosis, amyloidosis, infectious endocarditis and inflammation of cardiac implants.

This updated position paper from the German Society of Nuclear Medicine (DGN) and the German Cardiac Society (DGK) replaces the original statement from 2018. It gives an overview of the fields of application and the current value of nuclear cardiological imaging. The topics covered include chronic coronary syndrome, including viability diagnostics and the special value of positron emission tomography (PET), cardiomyopathies, cardiac sarcoidosis, amyloidosis, infectious endocarditis and inflammation of cardiac implants.

Scintigraphy using bone-avid tracers like 99mTc-diphosphono-propanodicarboxylic acid (99mTc-DPD), 99mTc-hydroxymethylene-diphosphonate (99mTc-HMDP), or 99mTc-pyrophosphate (99mTc-PYP) is a widely available and non-invasive imaging tool for diagnosis of cardiac amyloidosis. Visual evaluation and semi-quantitative image analyses reach excellent sensitivity and specificity results. For 99mTc-HMDP, high accuracy of early semi-quantitative parameters derived from imaging 10 min after tracer injection was described but never validated for other tracers. The aim of this study was to evaluate early semi-quantitative parameters in 99mTc-DPD scintigraphy. 122 patients (78 male / 44 female) with suspected cardiac amyloidosis who underwent 99mTc-DPD scintigraphy were retrospectively analysed. Early and late planar whole-body scintigraphy images were acquired 10 min (+ 5 min) and 2.5–3.5 h after tracer injection. Early cardiac 99mTc-DPD uptake was evaluated using the Heart/whole-body rectangular (H/WBr), Heart/whole-body profile (H/WBp), Heart/Skull (H/S), Heart/Mediastinum (H/M), Heart/Contralateral Lung (H/CL), Heart/Liver (H/L), and Heart/Pelvis (H/P) ratios. H/L was not correlated to the other parameters.Best results for prediction of Perugini ≥1 were achieved for H/M (sensitivity 69.6

123I-MIBG has been shown to visualize impaired cardiac neuronal function, but data of this imaging modality in patients with acute myocarditis are scarce. Nonetheless, an association with reduced cardiac function has been observed previously. The aim of this study was to establish and evaluate semi-quantitative and quantitative parameters in 123I-MIBG scintigraphy and SPECT/CT in patients with acute myocarditis and identify associations with left ventricular ejection fraction (LVEF) and biomarkers. Eight patients with acute myocarditis and a gender and age-matched control group who underwent 123I-MIBG scintigraphy and SPECT/CT were retrospectively analysed. Semi-quantitative Heart-to-Mediastinum (H/M) ratio and washout rate were calculated, additionally SPECT/CT system calibration and a whole-heart-segmentation were used for absolute quantification of tracer uptake. ROC analysis for the prediction of acute myocarditis and correlation of imaging parameters with LVEF and serological biomarkers was performed. Seven patients (87.5

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, driven by complex and dynamic molecular processes such as inflammation, fibrosis, metabolic dysregulation, thrombosis, and vascular remodeling. While conventional imaging techniques provide valuable anatomical and functional information, they fail to capture these underlying pathophysiological mechanisms at the molecular level. Molecular imaging, particularly with PET and SPECT, offers the potential to noninvasively visualize and quantify these processes, enabling earlier diagnosis, better risk stratification, and more precise treatment guidance. Despite substantial progress in clinical cardiology, there is a growing need for novel radiotracers that can target key disease-driving mechanisms beyond traditional perfusion or viability imaging. Emerging radiopharmaceuticals now enable the assessment of myocardial fibrosis (e.g., collagen-targeted and MMP-targeted tracers), cardiomyocyte stress responses (e.g., oxidative stress, unfolded protein response, endothelin signaling), and metabolic alterations (e.g., fatty acid, ketone, and glucose metabolism). Additionally, new tracers are being developed for thrombosis, vascular inflammation, plaque instability, and even for innovative targets such as cellular senescence and gut-derived inflammatory pathways. These developments reflect a paradigm shift towards imaging-driven phenotyping of cardiovascular disease. This review provides a comprehensive overview of the latest advances in molecular imaging tracers for cardiovascular applications, with a focus on their biological rationale, preclinical and clinical evidence, and translational challenges. We categorize tracers by their mechanistic targets and highlight their potential for integration into precision cardiology.

CT and CMR will be complementary modalities in the diagnostic work-up and risk stratification of patients with CA.We believe that molecular imaging will gain more and more importance in the next future, and will allow for an accurate assessment of the nature of the disease and its severity.It should also be noted that new tracers are under active investigation, both for AL [13] and ATTR-CA [14].Therefore, it is not unrealistic to foresee a bright future for the evolution of molecular imaging in this clinical setting.To achieve this goal, future research will need to answer important questions: (1) what is the exact significance of bone tracer uptake in ATTR-CA?(2) are there specific categories of patients with different outcome depending on SPECT or PET imaging markers?(3) are there other pathophysiological mechanisms which need to be elucidated?This collection aims to explore pre-clinical research and clinical applications of molecular imaging in the scenario of cardiac amyloidosis, highlighting its important role in improving patients' outcome and guiding therapeutic strategies.To this end, we warmly invite researchers to submit original research articles, systematic reviews, meta-analyses or interesting images for this collection issue.

Vertebral osteomyelitis is the third most common form of osteomyelitis in patients over 50 years of age.Whereas prompt (pathogen-directed) therapy is crucially associated with better outcomes, the heterogeneous clinical presentation of disease with unspecific symptoms often delays adequate treatment initiation. Diagnosis requires a careful investigation of medical history, clinical findings and diagnostic imaging, including magnetic resonance imaging and nuclear medicine techniques.Due to its high sensitivity, [18F]FDG PET/CT is becoming increasingly important in diagnosis and management of spondylodiscitis, especially in the postoperative setting with presence of spinal hardware or other implantable devices in which MRI is limited.

The randomized PETAL trial failed to demonstrate a benefit of interim FDG-PET (iPET)-based treatment intensification over continued standard therapy with CHOP (plus rituximab (R) in CD20-positive lymphomas). We hypothesized that PET analysis of all lymphoma manifestations may identify patients who benefitted from treatment intensification. A previously developed neural network was employed for iPET analysis to identify the highest pathological FDG uptake (max-SUV AI ) and the mean FDG uptake of all lymphoma manifestations (mean-SUV AI ). High mean-SUV AI uptake was determined separately for iPET-positive and iPET-negative patients. The endpoint was time-to-progression (TTP). There was a significant interaction of additional rituximab and mean-SUV AI in the iPET-negative group (HR = 0.6, p < 0.05). Patients with high mean-SUV AI had significantly prolonged TTP when treated with 6xR-CHOP + 2 R (not reached versus 52 months, p < 0.05), whereas max-SUV manual failed to show an impact of additional rituximab. In the iPET-positive group, patients with high mean-SUV AI had a significantly longer TTP with (R-)CHOP than with the Burkitt protocol (14 versus 4 months, p < 0.01). Comprehensive iPET evaluation may provide new prognosticators in aggressive lymphoma. Additional application of rituximab was associated with prolonged TTP in iPET-negative patients with high mean-SUV AI . Comprehensive iPET interpretation could identify high-risk patients who benefit from study-specific interventions.

The study aimed to investigate the prevalence, phenotypic characteristics, and predictors of atrial fibrillation (AF) in patients presenting with cardiac amyloidosis (CA) of light-chain (AL) or transthyretin (ATTR) type. Clinical, biochemical, and echocardiographic data of patients presenting with CA between 2005 and 2020 were retrospectively collected. CA staging was based on established biomarker systems. Binomial logistic regression was run to analyse the effects of clinical variables on the likelihood of AF. The study included 133 patients [53% AL, 41% wild-type (wt) ATTR-CA, & 6% hereditary ATTR-CA]. Mean age was 71 years, and 80% were male patients. AF was diagnosed in 64 (48%) patients (28% in AL-CA, 80% in wtATTR, 13% in hATTR, P  < 0.001). Patients with AF were older (74 vs. 69 years, P  < 0.001), more likely to have wtATTR-CA (67 vs. 16%, P  < 0.001), exhibited more often New York Heart Association ≥ III symptoms (66 vs. 45%, P  = 0.02) and carried a higher burden of comorbidities. AF patients had lower left ventricular ejection fraction (47 vs. 53%, P  < 0.005), higher left atrial volume index (54 vs. 46 mL/m 2 , P  = 0.007), higher pulmonary artery pressure (42 vs. 31 mmHg, P  = 0.008), and worse tricuspid annular plane systolic excursion values (17 vs. 20 mm, P  = 0.01). Mitral regurgitation ≥ Grade 2 was more frequent in AF (56 vs. 25%, P  < 0.001). Higher ATTR-CA stage was associated with higher AF prevalence (47% vs. 74% vs. 94%, P  < 0.001, for Stages I, II, & III, respectively). Higher AL-CA stage was associated with lower AF prevalence (0% vs. 40% vs. 31% vs. 18%, P  < 0.001, for Stages I, II, IIIa, & IIIb, respectively). Three independent predictors for AF were identified in a multivariate logistic regression model with 81.5% classification accuracy: AL type [odds ratio (OR) 0.1, confidence interval (CI) 0.01–0.29, P  = 0.001], estimated glomerular filtration rate (OR 0.9, CI 0.93–0.99, P  = 0.03), and body mass index (OR 1.3, CI 1.07–1.66, P  = 0.01). ATTR amyloidosis was associated with a 10-fold higher risk of AF. During 1 year follow-up, only one episode of ischaemic stroke was reported. Atrial fibrillation affects nearly half of all patients with CA. Patients presenting with AF have more severe symptoms and higher burden of comorbidities. ATTR type of amyloidosis is the strongest predictor of AF. Prospective screening for occult AF may be considered in ATTR-CA.

Radiosynoviorthesis (RSO) is a decades known, effective intra-articular nuclear medicine local therapy, with few rare side-effects, in which inflamed synovial membrane is treated by means of colloidal beta-emitters. There are major variations worldwide in terms of acceptance, frequency of use and approved indications for this procedure. Thus, reliable figures that reflect reality are only available for a few countries. A Europe-wide survey revealed that RSO is carried out most frequently in Germany, where RSO is the most common nuclear medicine therapy with about 70,000 joints treated per year. The main indications include synovitis due to rheumatoid arthritis, hemophilia and pigmented villonodular synovitis (PVNS), and depending on national approvals, osteoarthritis. Despite the many indications, there are very few published scientific studies and therefore, RSO evidence is lacking. Reliable data on the clinical usage of RSO and demographics of RSO specialists are only available in Germany, thus we discuss the future challenges of RSO mainly from a German perspective. In the German healthcare system, RSO is performed primarily on an outpatient basis and plays only a minor role in the university setting. The necessary expertise for RSO is therefore lacking, for the most part, at university training centers. Currently, nearly more than three quarters of the German RSO experts are over fifty years old, illustrating a shortage of young talent. In the future, RSO providers from the non-university or private sector will have to cooperate with universities through networks and will have to intensify their cooperation with referring physicians, such as rheumatologist and orthopedic surgeons, and patients in order to maintain a timely and beneficial exchange of information. In networks of RSO experts, the participants must jointly develop and establish training concepts and facilities for future talents, elaborate on guidelines, if clinically useful expand the range of indications, initiate studies to generate further evidence and finally make the procedure more public. In addition, it is worthwhile to apply this process beyond human medicine to other fields, such as medical physics and veterinary medicine. If these points are implemented, the future of RSO will be bright, if it fails, it looks bleak.