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Der Nuklearmediziner 2010; 33(2): 113-119
DOI: 10.1055/s-0030-1252001
Myokardszintigrafie – 2010

© Georg Thieme Verlag KG Stuttgart · New York

Myokardperfusionsszintigrafie mit SPECT/CT und PET/CT

Myocardial Perfusion Imaging Using SPECT/CT and PET/CTM. Hacker1 , C. Übleis1
  • 1Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München
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Publication History

Publication Date:
31 May 2010 (online)

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Zusammenfassung

Mit dem technischen Fortschritt auf dem Gebiet der Mehrzeilen-CT wird die CT-Koronarangiografie zunehmend als nicht-invasive Alternative zur diagnostischen Herzkatheterisierung angesehen. Jedoch werden Bildqualität und Interpretation dieser neuen Technik von Wackel- und Aufhärtungsartefakten, Problemen durch Fehlregistrierung oder durch die mangelnde Erfahrung des Untersuchers beeinträchtigt. Die Kombination der CT-Angiografie mit einer SPECT oder PET-Myokardperfusionsuntersuchung unter Belastungsbedingungen, sei es mittels Hybridscanner oder durch den Einsatz zweier getrennter Geräte, ermöglicht eine umfassende nicht-invasive, kombiniert anatomisch-funktionelle Diagnostik des Herzens. Zusätzlich wird dadurch eine 3-dimensionale Bildfusion von SPECT/PET und CT Daten möglich, welche allerdings mit den derzeit erhältlichen Softwarepaketen noch mit erheblichem Zeitaufwand durch zahlreiche manuelle Interventionen verbunden ist. Die Kombination aus CT-Angiografie und Myokard-PET wird einerseits als SPECT-Ersatz, andererseits aber auch in Ergänzung zur SPECT-Perfusionuntersuchung durch den Einsatz neuer Biomarker zur Vitalitäts-, Apoptose- oder Koronarplaque-Diagnostik künftig einen deutlich größeren Raum einnehmen, als dies derzeit der Fall ist.

Abstract

With technical progress coronary CT angiography is increasingly accepted as a noninvasive alternative in morphological imaging. However, image quality and interpretation are still influenced by various factors like blooming artifacts, misregistration and the experience of the interpreter. The combination with stress-rest myocardial perfusion SPECT or PET as a hybrid scanner or two standalone scanners enables comprehensive noninvasive anatomical and functional imaging of the heart as well as three dimensional image fusion. Hybrid-imaging is feasible with today's commercially available software packages but still requires time demanding manual intervention and experienced interpretation. PET investigations, either in replacement of SPECT for perfusion measurements, or in addition with new biomarkers will provide even more impact to hybrid imaging in future.

Schlüsselwörter

Myokardperfusionszintigrafie - Computertomografie - SPECT - PET

Key words

myocardial scintygraphy - computed tomography - SPECT - PET

Literatur

  • 1 Anand DV, Lim E, Hopkins D. et al . Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy.  Eur Heart J. 2006;  27 713-721
    CrossrefPubMedGoogle Scholar
  • 2 Anand DV, Lim E, Raval U. Prevalence of silent myocardial ischemia in asymptomatic individuals with subclinical atherosclerosis detected by electron beam tomography.  J Nucl Cardiol. 2004;  11 450-457
    CrossrefPubMedGoogle Scholar
  • 3 Berman DS, Wong ND, Gransar H. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography.  J Am Coll Cardiol. 2004;  44 923-930
    CrossrefPubMedGoogle Scholar
  • 4 Brindis RG, Douglas PS, Hendel RC. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association.  J Am Coll Cardiol. 2005;  46 1587-1605
    CrossrefPubMedGoogle Scholar
  • 5 Chamuleau SA, Meuwissen M, Koch KT. Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis.  Am J Cardiol. 2002;  89 377-380
    CrossrefPubMedGoogle Scholar
  • 6 Di Carli MF, Dorbala S, Curillova Z. Relationship between CT coronary angiography and stress perfusion imaging in patients with suspected ischemic heart disease assessed by integrated PET-CT imaging.  J Nucl Cardiol. 2007;  14 799-809
    CrossrefPubMedGoogle Scholar
  • 7 Faber TL, Santana CA, Garcia EV. Three-dimensional fusion of coronary arteries with myocardial perfusion distributions: clinical validation.  J Nucl Med. 2004;  45 745-753
    PubMedGoogle Scholar
  • 8 Gaemperli O, Kaufmann PA. Hybrid cardiac imaging: more than the sum of its parts?.  J Nucl Cardiol. 2008;  15 123-126
    CrossrefPubMedGoogle Scholar
  • 9 Gaemperli O, Schepis T, Kalff V. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography.  Eur J Nucl Med Mol Imaging. 2007;  34 1097-1106
    CrossrefPubMedGoogle Scholar
  • 10 Gaemperli O, Schepis T, Kalff V. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography.  Eur J Nucl Med Mol Imaging. 2007;  34 1097-1106
    CrossrefPubMedGoogle Scholar
  • 11 Gaemperli O, Schepis, Kaufmann PA. SPECT-CT fusion imaging integrating anatomy and perfusion.  Eur Heart J. 2007;  28 145
    CrossrefPubMedGoogle Scholar
  • 12 Gaemperli O, Schepis T, Koepfli P. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT.  Eur J Nucl Med Mol Imaging. 2007;  34 1162-1171
    CrossrefPubMedGoogle Scholar
  • 13 Gaemperli O, Schepis T, Valenta I. Cardiac image fusion from stand-alone SPECT and CT: clinical experience.  J Nucl Med. 2007;  48 696-703
    CrossrefPubMedGoogle Scholar
  • 14 Gaemperli O, Schepis T, Valenta I. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT.  Radiology. 2008;  248 414-423
    CrossrefPubMedGoogle Scholar
  • 15 Gibbons RS. American Society of Nuclear Cardiology project on myocardial perfusion imaging: measuring outcomes in response to emerging guidelines.  J Nucl Cardiol. 1996;  3 436-442
    CrossrefPubMedGoogle Scholar
  • 16 Goetze S, Wahl RL. Prevalence of misregistration between SPECT and CT for attenuation-corrected myocardial perfusion SPECT.  J Nucl Cardiol. 2007;  14 200-206
    CrossrefPubMedGoogle Scholar
  • 17 Hacker M, Jakobs T, Hack N. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina.  Eur J Nucl Med Mol Imaging. 2007;  34 4-10
    CrossrefPubMedGoogle Scholar
  • 18 Hacker M, Jakobs T, Hack N. Combined use of 64-slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenoses. First results in a clinical setting concerning patients with stable angina.  Nuklearmedizin. 2007;  46 29-35
    PubMedGoogle Scholar
  • 19 Hacker M, Jakobs T, Matthiesen F. Combined functional and morphological imaging consisting of gated myocardial perfusion SPECT and 16-detector multislice spiral CT angiography in the noninvasive evaluation of coronary artery disease: first experiences.  Clin Imaging. 2007;  31 313-320
    CrossrefPubMedGoogle Scholar
  • 20 Hacker M, Jakobs T, Matthiesen F. Comparison of Spiral Multidetector CT Angiography and Myocardial Perfusion Imaging in the Noninvasive Detection of Functionally Relevant Coronary Artery Lesions: First Clinical Experiences.  J Nucl Med. 2005;  46 1294-1300
    PubMedGoogle Scholar
  • 21 He ZX, Hedrick TD, Pratt CM. Severity of coronary artery calcification by electron beam computed tomography predicts silent myocardial ischemia.  Circulation. 2000;  101 244-251
    CrossrefPubMedGoogle Scholar
  • 22 Iskander S, Iskandrian AE. Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging.  J Am Coll Cardiol. 1998;  32 57-62
    CrossrefPubMedGoogle Scholar
  • 23 Klocke FJ, Baird MG, Lorell BH. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging – executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging).  Circulation. 2003;  108 1404-1418
    CrossrefPubMedGoogle Scholar
  • 24 Libby P. Current concepts of the pathogenesis of the acute coronary syndromes.  Circulation. 2001;  104 365-372
    CrossrefPubMedGoogle Scholar
  • 25 Moser KW, O’Keefe Jr. JH, Bateman TM. Coronary calcium screening in asymptomatic patients as a guide to risk factor modification and stress myocardial perfusion imaging.  J Nucl Cardiol. 2003;  10 590-598
    CrossrefPubMedGoogle Scholar
  • 26 Nakaura T, Utsunomiya D, Shiraishi S. Three-dimensional cardiac image fusion using new CT angiography and SPECT methods.  Am J Roentgenol. 2005;  185 1554-1557
    CrossrefPubMedGoogle Scholar
  • 27 Nakaura T, Utsunomiya D, Shiraishi S. Images in cardiovascular medicine. Fusion imaging between myocardial perfusion single photon emission computed tomography and cardiac computed tomography.  Circulation. 2005;  112 e47-e48
    CrossrefPubMedGoogle Scholar
  • 28 Rispler S, Keidar Z, Ghersin E. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions.  J Am Coll Cardiol. 2007;  49 1059-1067
    CrossrefPubMedGoogle Scholar
  • 29 Rozanski A, Gransar H, Wong ND. Clinical outcomes after both coronary calcium scanning and exercise myocardial perfusion scintigraphy.  J Am Coll Cardiol. 2007;  49 1352-1361
    CrossrefPubMedGoogle Scholar
  • 30 Rumberger JA, Simons DB, Fitzpatrick LA. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study.  Circulation. 1995;  92 2157-2162
    CrossrefPubMedGoogle Scholar
  • 31 Sato A, Hiroe M, Tamura M. Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging.  J Nucl Med. 2008;  49 564-572
    CrossrefPubMedGoogle Scholar
  • 32 Schepis T, Gaemperli O, Koepfli P. Use of coronary calcium score scans from stand-alone multislice computed tomography for attenuation correction of myocardial perfusion SPECT.  Eur J Nucl Med Mol Imaging. 2007;  34 11-19
    CrossrefPubMedGoogle Scholar
  • 33 Schindler TH, Magosaki N, Jeserich M. 3D assessment of myocardial perfusion parameter combined with 3D reconstructed coronary artery tree from digital coronary angiograms.  Int J Card Imaging. 2000;  16 1-12
    CrossrefPubMedGoogle Scholar
  • 34 Schindler TH, Magosaki N, Jeserich M. Fusion imaging: combined visualization of 3D reconstructed coronary artery tree and 3D myocardial scintigraphic image in coronary artery disease.  Int J Card Imaging. 1999;  15 357-368 discussion 369–370
    CrossrefPubMedGoogle Scholar
  • 35 Smith Jr. SC, Dove JT, Jacobs AK. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions.  Circulation. 2001;  103 3019-3041
    PubMedGoogle Scholar
  • 36 Thompson RC, McGhie AI, Moser KW. Clinical utility of coronary calcium scoring after nonischemic myocardial perfusion imaging.  J Nucl Cardiol. 2005;  12 392-400
    CrossrefPubMedGoogle Scholar
  • 37 Topol EJ, Nissen SE. Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease.  Circulation. 1995;  92 2333-2342
    CrossrefPubMedGoogle Scholar
  • 38 Uebleis C, Becker A, Griesshammer I. Stable coronary artery disease: prognostic value of myocardial perfusion SPECT in relation to coronary calcium scoring - long-term follow-up.  Radiology. 2009;  252 682-690
    CrossrefPubMedGoogle Scholar
  • 39 White CW, Wright CB, Doty DB. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis?.  N Engl J Med. 1984;  310 819-824
    CrossrefPubMedGoogle Scholar

Korrespondenzadresse

PD Dr. Marcus Hacker

Klinik und Poliklinik für

Nuklearmedizin

Marchioninistraße 15

81377 München

Phone: +49/89/7095 7655

Fax: +49/89/7095 7646

Email: marcus.hacker@med.uni-muenchen.de

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