Herz-Kreislauf-Erkrankungen sind die häufigste Todesursache in Deutschland. In Kombination
ermöglichen klinische Kriterien und geeignete Bildgebungsverfahren eine präzise Diagnosefindung
und führen zur Einleitung einer passenden Therapie. Nuklearmedizinische bildgebende
Verfahren sind Funktionsuntersuchungen, die biologische Prozesse sichtbar machen.
Dieser Beitrag bietet eine Übersicht aktueller nuklearmedizinischer Bildgebungsmethoden
für kardiale Fragestellungen.
Abstract
Cardiac nuclear medicine comprises various diagnostic techniques using radiopharmaceuticals
for functional imaging in vivo. This article provides an overview of current clinical
use of cardiac imaging in nuclear medicine in Germany: Myocardial perfusion imaging
using SPECT is a well-established noninvasive tool to semi-quantitatively measure
left ventricular myocardial perfusion. Ischemia and chronic myocardial scars can be
idenified with a high diagnostic accuracy. Gated SPECT enables measuring left ventricular
function. With new dedicated solid-state camera systems examinations have become faster
and better while radiation exposure has been minimized. These new camera systems allow
quantitative calculations of myocardial blood flow, which will further improve diagnostic
accuracy.
For patients with severe chronic coronary artery disease and myocardial dysfunction
analyzing myocardial viability is crucial for guiding therpeutic decisions. For detection
of hibernating myocardium and its differentiation from scar tissue, two nuclear cardiac
methods are combined: Rest myocardial perfusion imaging detects perfusion defects
and cardiac 18F-FDG-PET/CT detects glucose metabolism in the hypoperfused area. As
long as glucose metabolism is intact therapeutic interventions can be beneficial.
In general 18F-FDG-PET/CT allows visualization and quantification of celluar glucose
metabolism in oncologic and inflammatory processes. For analysis of cardiac inflammation
(e. g. endocarditis or sarcoidosis) a no-carb and high-protein diet is needed at leat
24 hours prior to imaging in order to suppress the physiologic myocardial glucose
metabolism. Then, specific inflammatory tracer uptake can be assessed.
Cardiac amyloidosis is a rare but dangerous condition. With a specific amyloidosis
scintigraphy (bone scintigraphy), cardiac ATTR-amyloidosis can be diagnosed with high
accuracy. A potenitally harmful myocardial biopsy often is not needed any more and
specific therapy can be initiated.
In summary, diagnostic methods in cardiac nuclear medicine non-invasively allow visualization
and function analysis of biological processes and are essential for diagnosis finding
and therapy guidance. The continuous advancement of diagnostic tools makes nuclear
cardiology a highly relevant and interesting field.
Schlüsselwörter
molekulare Funktionsbildgebung - PET - SPECT - koronare Herzerkrankung - kardiale
Entzündung
Key words
molecular imaging - PET - SPECT - coronary artery disease - cardiac inflammation
