SPECT/CT in der Nuklearkardiologischen Bildgebung

Zusammenfassung

Neue Entwicklungen sowohl hardware- als auch softwareseitig haben in den letzten Jahren dazu beigetragen, dass Methoden der Hybridbildgebung auch in der nuklearkardiologischen Klinik Einzug halten. Die myokardiale Perfusions-SPECT/CT eröffnet neue Möglichkeiten der Schwächungs- und Streustrahlungskorrektur, was Zugewinne in der diagnostischen Genauigkeit und Sicherheit erbringt. Die gleichzeitige Evaluierung der koronaren Kalklast sowie der myokardialen Perfusion kann bei unauffälligem Befund eine KHK mit großer Sicherheit ausschließen und verbessert gleichzeitig die Identifizierung von Hochrisikopatienten. Die Fusion von computertomografisch dargestellten arteriellen Koronarbäumen mit funktionellen SPECT-Perfusionsdaten verbessert die Zuordnung von ischämischen Herzmuskelarealen zu den entsprechenden Gefäßversorgungsarealen und erleichtert die Identifizierung von hämodynamisch relevanten Stenosen und potenziell vulnerablen Gefäßplaques. Sensitivität und Spezifität der Einzeluntersuchungen verbessern sich synergistisch. Die Überlagerung der venösen myokardialen Gefäßanatomie mit Perfusionskarten des linken Ventrikels kann bei der Planung zur gezielten Einbringung von Schrittmachersonden wertvolle Informationen liefern, mittels gated-SPECT und Phasenanalyse ist es zudem möglich, geeignete Patientenkollektive zu selektionieren. Postinterventionell können mittels Hybridbildgebung das Therapieansprechen evaluiert und ggf. Korrekturen vorgenommen werden.

Schließlich erlauben Fortschritte auf den Gebieten der Schwächungs- und Streustrahlungskorrektur und der Rekonstruktion von SPECT-Perfusionsdatensätzen eine absolute Quantifizierung des myokardialen Blutflusses und der myokardialen Flussreserve sowie des myokardialen Tracer-Uptakes, was neue Möglichkeiten v.a. der Detektion von Hochrisikopatienten eröffnen wird.

Durch die Hybridbildgebung wird die lange etablierte myokardiale Perfusionsszintigrafie ihren herausragenden Stellenwert bei der Diagnose und der Risikostratifizierung der KHK weiter behaupten und ausbauen können.

Abstract

Recent advances in hardware and software development have contributed to the increasing importance of hybrid imaging techniques in nuclear cardiology over the last few years.

Myocardial perfusion SPECT/CT opens up new possibilities for attenuation and scatter correction, which leads to gains in diagnostic accuracy and safety. The simultaneous evaluation of the coronary plaque burden as well as the myocardial perfusion can exclude CAD with high certainty in case of inconspicuous findings and at the same time improves the identification of high-risk patients. The concomitant use of myocardial SPECT and contrast enhanced arterial CT coronary angiography allows the fusion of coronary trees with functional SPECT-perfusion data and improves the attribution of ischemic heart muscle to the corresponding vessel territories. Furthermore, it facilitates the identification of hemodynamically relevant stenoses and potentially vulnerable plaques. Sensitivity and specificity of the individual examinations are improved through the synergistic effects of hybrid imaging. The fusion of myocardial venous anatomy with perfusion maps of the left ventricle can provide valuable information for guiding cardiac resynchronization therapy. Gated-SPECT and phase analysis can facilitate the selection of suitable patient cohorts. Hybrid imaging can be employed for therapy monitoring and outcome evaluation after interventions.

Finally, advances in the fields of attenuation and scatter correction as well as improved construction algorithms of SPECT perfusion data allow for the absolute quantification of myocardial blood flow and myocardial flow reserve as well as myocardial tracer uptake. This might offer new possibilities for the detection of high-risk patients.

Due to hybrid imaging, the long established method of myocardial perfusion scintigraphy will likely be able to further assert and extend its outstanding value in the diagnosis and risk stratification of CAD patients.

Schlüsselwörter

SPECT/CT - CCTA - CACS - Hybridbildgebung - Myokardperfusion

Key words

SPECT/CT - CCTA - CACS - hybrid imaging - myocardial perfusion imaging

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