EKG-getriggerte (gated) SPECT zur integrierten Beurteilung von linksventrikulärer Funktion, Perfusion und Vitalität

Zusammenfassung

Im Rahmen der myokardialen Perfusionsdiagnostik erlaubt die herzphasengetriggerte SPECT-Akquisition ohne relevanten Mehraufwand die Bestimmung der Wandbewegung und -verdickung sowie die Berechnung der enddiastolischen und endsystolischen linksventrikulären Ventrikelvolumina und der Ejektionsfraktion. Der vorliegende Artikel gibt einen Überblick über Technik und Fallgruben der gated-SPECT und die Validität der mit dieser Technik erhobenen Daten und Befunde. Darüber hinaus wird die diagnostische und prognostische Relevanz des Verfahrens anhand klinischer Studien dargelegt.

Abstract

When used for myocardial perfusion imaging, ECG-gated SPECT acquisition yields wall motion, wall thickening, end-diastolic and end-systolic left ventricular volumes and ejection fraction to be calculated without a greater additional effort. This paper gives an overview of the methods and pitfalls of gated SPECT and the validity of data and findings obtained with this method. Also, the method’s diagnostic and prognostic relevance are shown by means of clinical studies.

Schlüsselwörter

Myokardperfusionsszintigraphie - SPECT - EKG-Triggerung - gated-SPECT - linksventrikuläre Funktion

Key words

Myocardial perfusion scintigraphy - SPECT - ECG-gating - gated SPECT - left ventricular function

Literatur

• 1 Atsma D E, Bavelaar-Croon C D, Germano G. et al . Good correlation between gated single photon emission computed myocardial tomography and contrast ventriculography in the assessment of global and regional left ventricular function.  Int J Card Imaging. 2000;  16 447-453
• 2 Choragudi N L, Prakash A M, Sun Y. et al . Comparison of echocardiography with technetium 99m-gated single photon emission computed tomography as diagnostic tools for left ventricular ejection fraction.  Echocardiography. 2001;  18 627-632
• 3 DePuey E G, Rozanski A. Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact.  J Nucl Med. 1995;  36 952-955
• 4 Ficaro E P, Quaife R A, Kritzman J N. et al . Accuracy and reproducibility of 3D-MSPECT for estimating left ventricular ejection fraction in patients with severe perfusion abnormalities [abstract].  Circulation. 1999;  100 (Suppl I) 26
• 5 Germano G, Kiat H, Kavanagh P B, Chen J. et al . Automatic quantification of ejection fraction from gated myocardial perfusion SPECT.  J Nucl Med. 1995;  36 2138-2147
• 6 Hashimoto J, Kubo A, Iwasaki R. et al . Gated single-photon emission tomography imaging protocol to evaluate myocardial stunning after exercise.  Eur J Nucl Med. 1999;  26 1541-1546
• 7 Ioannidis J P, Trikalinos T A, Danias P G. Electrocardiogram-gated single-photon emission computed tomography versus cardiac magnetic resonance imaging for the assessment of left ventricular volumes and ejection fraction: a meta-analysis.  J Am Coll Cardiol. 2002;  39 2059-2068
• 8 Johnson L L, Verdesca S A, Aude W Y. et al . Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms.  J Am Coll Cardiol. 1997;  30 1641-1648
• 9 Kumita S, Cho K, Nakajo H. et al . Assessment of left ventricular diastolic function with electrocardiography-gated myocardial perfusion SPECT: comparison with multigated equilibrium radionuclide angiography.  J Nucl Cardiol. 2001;  8 568-574
• 10 Lipke C, Kühl H P, Nowak B, Kaiser H-J, Reinartz P, Koch K C, Buell U, Schaefer W M. Validation of 4D-MSPECT and QGS for Quantification of Left Ventricular Volumes and Ejection Fraction from Gated ^99mTc-MIBI SPET: Comparison with Cardiac Magnetic Resonance Imaging.  Eur J Nucl Med Mol Imaging. 2004;  31 482-490
• 11 Schaefer W M, Lipke C, Nowak B. et al . Validation of QGS and 4D-MSPECT for Quantification of Left Ventricular Volumes and Ejection Fraction from Gated ¹⁸F-FDG PET: Comparison with Cardiac MRI.  J Nucl Med. 2004;  45 74-79
• 12 Schaefer W M, Lipke C, Nowak B. et al . Validation of an evaluation routine for left ventricular volumes, ejection fraction and wall motion from gated cardiac FDG PET: a comparison with cardiac magnetic resonance imaging.  Eur J Nucl Med Mol Imaging. 2003;  30 545-553
• 13 Sharir T, Bacher-Stier C, Dhar S. et al . Identification of severe and extensive coronary artery disease by postexercise regional wall motion abnormalities in Tc-99m sestamibi gated single photon emission computed tomography.  Am J Cardiol. 2000;  86 1171-1175
• 14 Sharir T, Germano G, Kavanagh P B. et al . Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography.  Circulation. 1999;  100 1035-1042
• 15 Stollfuss J C, Haas F, Matsunari I. et al . ^99mTc-tetrofosmin SPECT for prediction of functional recovery defined by MRI in patients with severe left ventricular dysfunction: additional value of gated SPECT.  J Nucl Med. 1999;  40 1824-1831
• 16 White H D, Norris R M, Brown M A. et al . Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction.  Circulation. 1987;  76 44-51
• 17 Yamaguchi A, Ino T, Adachi H. et al . Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy.  Ann Thorac Surg. 1998;  5 434-438