Download PDF
Der Nuklearmediziner 2004; 27(3): 169-175
DOI: 10.1055/s-2004-822720
Kardiologie aktuell

© Georg Thieme Verlag Stuttgart · New York

Myokardszintigraphie: Durchführung, Dokumentation und überweiserfreundlicher Befund

Myocardial Perfusion Scan: Performance, Documentation and User-Friendly ReportingH. P. Bülow1 , F. M. Bengel1
  • 1Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Germany
Further Information

Publication History

Publication Date:
16 September 2004 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Myokardszintigraphie stellt seit vielen Jahren einen wichtigen Baustein in der nicht-invasiven kardialen Diagnostik bei vermuteter oder bekannter koronarer Herzkrankheit dar. Aufgrund der unterschiedlichen zur Verfügung stehenden Radiopharmaka, der Kombination aus Ruhe und körperlicher oder pharmakologischer Belastung sowie der verschiedenen Kamerasysteme ist eine Vielzahl unterschiedlicher Untersuchungsprotokolle möglich. Um einen möglichst standardisierten Untersuchungsablauf zu gewährleisten, existieren eine Reihe von Richtlinien, die sich mit diesem Thema befassen und als Referenz dienen können. Der Befundbericht, als letzter Teil der Myokardszintigraphie, schließt die Untersuchung ab. Dieser Teil der Untersuchung stellt das Verbindungsglied zum Überweiser dar, so dass ihm eine besondere Bedeutung zukommt. Es empfiehlt sich ein systematischer Aufbau mit gleich bleibender und allgemein akzeptierter Nomenklatur, um dem Überweiser die Interpretation der Ergebnisse zu erleichtern. Überdies kann durch eine klare Bewertung des Untersuchungsergebnisses und eine konkrete Beantwortung der Fragestellung des Überweisers die Akzeptanz der Myokardszintigraphie als klinische Methode gewährleistet werden.

Abstract

Myocardial perfusion imaging plays an important role in the non-invasive diagnostic work-up of patients with suspected or known coronary artery disease for many years now. As a result of different radiopharmaceuticals, the combination of a resting with a stress study, the application of either physical exercise or pharmacological stress and the availability of different camera systems, several imaging protocols exist. In order to assure relatively standardized perfusion studies, several guidelines concerning the performance of perfusion imaging have been published, which may be used as a reference. The report represents the final part of a perfusion study. As it is the linkage to the clinician, who ordered the scan, it is of particular importance. Therefore, a systematic structure and a commonly used nomenclature is recommended, helping the clinician to interpret the study results. Moreover, an explicit assessment and a clear answer to the clinical question guarantees the acceptance of myocardial perfusion imaging as a clinical method.

Schlüsselwörter

Richtlinien - Befundbericht - Standardisierung - Untersuchungsprotokolle

Key words

Guidelines - report - standardisation - study protocols

Literatur

  • 1 Anagnostopoulos C, Harbinson M, Kelion A, Kundley K, Loong C Y, Notghi A, Reyes E, Tindale W, Underwood S R. Procedure guidelines for radionuclide myocardial perfusion imaging.  Nucl Med Commun. 2003;  24 1105-1119
    PubMedGoogle Scholar
  • 2 ASNC . Imaging guidelines for nuclear cardiology procedures, part 2.  J Nucl Cardiol. 1999;  6 G47-G84
    CrossrefPubMedGoogle Scholar
  • 3 ASNC . Updated imaging guidelines for nuclear cardiology procedures, part 1.  J Nucl Cardiol. 2001;  8 G5-G58
    CrossrefPubMedGoogle Scholar
  • 4 Cerqueira M D. The user-friendly nuclear cardiology report: what needs to be considered and what is included.  J Nucl Cardiol. 1996;  3 350-355
    CrossrefPubMedGoogle Scholar
  • 5 Cerqueira M D, Weissman N J, Dilsizian V, Jacobs A K, Kaul S, Laskey W K, Pennell D J, Rumberger J A, Ryan T, Verani M S. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.  J Nucl Cardiol. 2002;  9 240-245
    CrossrefPubMedGoogle Scholar
  • 6 Chaitman B R. Exercise stress testing. In: Braunwald E (ed). Heart Disease. 5th ed. WB Saunders Company, Philadelphia 1997: 153-176
    Google Scholar
  • 7 Corbett J R, Kritzman J N, Ficaro E P. Attenuation correction for single photon emission computed tomography myocardial perfusion imaging.  Curr Cardiol Rep. 2004;  6 32-40
    PubMedGoogle Scholar
  • 8 Cuocolo A, Soricelli A, Pace L, Nicolai E, Castelli L, Nappi A, Imbriaco M, Morisco C, Ell P J, Salvatore M. Adenosine technetium-99m-methoxy isobutyl isonitrile myocardial tomography in patients with coronary artery disease: comparison with exercise.  J Nucl Med. 1994;  35 1110-1115
    PubMedGoogle Scholar
  • 9 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
    PubMedGoogle Scholar
  • 10 Dogruca Z, Kabasakal L, Yapar F, Nisil C, Vural V A, Onsel Q. A comparison of Tl-201 stress-reinjection-prone SPECT and Tc-99m-sestamibi gated SPECT in the differenziation of inferior wall defects from artifacts.  Nucl Med Commun. 2000;  21 719-727
    CrossrefPubMedGoogle Scholar
  • 11 Friedman J, Van Train K, Maddahi J, Rozanski A, Prigent F, Bietendorf J, Waxman A, Berman D S. “Upward creep” of the heart: a frequent source of false-positive reversible defects during thallium-201 stress-redistribution SPECT.  J Nucl Med. 1989;  30 1718-1722
    PubMedGoogle Scholar
  • 12 Gibbons R J, Balady G J, Timothy Bricker J, Chaitman B R, Fletcher G F, Froelicher V F, Mark D B, McCallister B D, Mooss A N, O'Reilly M G, Winters W L, Antman E M, Alpert J S, Faxon D P, Fuster V, Gregoratos G, Hiratzka L F, Jacobs A K, Russell R O, Smith S C. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines).  J Am Coll Cardiol. 2002;  40 1531-1540
    CrossrefPubMedGoogle Scholar
  • 13 Glover D K, Ruiz M, Yang J Y, Koplan B A, Allen T R, Smith W H, Watson D D, Barrett R J, Beller G A. Pharmacological stress thallium scintigraphy with 2-cyclohexylmethylidenehydrazinoadenosine (WRC-0470). A novel, short-acting adenosine A2A receptor agonist.  Circulation. 1996;  94 1726-1732
    PubMedGoogle Scholar
  • 14 Gonzalez P, Canessa J, Massardo T. Formal aspects of the user-friendly nuclear cardiology report.  J Nucl Cardiol. 1998;  5 365-366
    CrossrefPubMedGoogle Scholar
  • 15 Hachamovitch R, Hayes S W, Friedman J D, Cohen I, Berman D S. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography.  Circulation. 2003;  107 2900-2907
    CrossrefPubMedGoogle Scholar
  • 16 Hendel R C, Wackers F J, Berman D S, Ficaro E, Depuey E G, Klein L, Cerqueira M. American society of nuclear cardiology consensus statement: reporting of radionuclide myocardial perfusion imaging studies.  J Nucl Cardiol. 2003;  10 705-708
    CrossrefPubMedGoogle Scholar
  • 17 Iskander S, Iskandrian A E. Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging.  J Am Coll Cardiol. 1998;  32 57-62
    CrossrefPubMedGoogle Scholar
  • 18 Kapur A, Latus K A, Davies G, Dhawan R T, Eastick S, Jarritt P H, Roussakis G, Young M C, Anagnostopoulos C, Bomanji J, Costa D C, Pennell D J, Prvulovich E M, Ell P J, Underwood S R. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study.  Eur J Nucl Med Mol Imaging. 2002;  29 1608-1616
    CrossrefPubMedGoogle Scholar
  • 19 Klocke F J, Baird M G, Lorell B H, Bateman T M, Messer J V, Berman D S, O'Gara P T, Carabello B A, Russell R O, Cerqueira M D, St John Sutton M G, DeMaria A N, Udelson J E, Kennedy J W, Verani M S, Williams K A, Antman E M, Smith S C, Alpert J S, Gregoratos G, Anderson J L, Hiratzka L F, Faxon D P, Hunt S A, Fuster V, Jacobs A K, Gibbons R J, Russell R O. 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
  • 20 Knapp W H, Bentrup A, Schmidt U, Ohlmeier H. Myocardial scintigraphy with thallium-201 and technetium-99m-hexakis-methoxyisobutylisonitrile in left bundle branch block: a study in patients with and without coronary artery disease.  Eur J Nucl Med. 1993;  20 219-224
    PubMedGoogle Scholar
  • 21 Santos-Ocampo C D, Herman S D, Travin M I, Garber C E, Ahlberg A W, Messinger D E, Heller G V. Comparison of exercise, dipyridamole, and adenosine by use of technetium 99m sestamibi tomographic imaging.  J Nucl Cardiol. 1994;  1 57-64
    PubMedGoogle Scholar
  • 22 Schafers M. [Methods and clinical applications in nuclear cardiology: a position statement].  Nuklearmedizin. 2002;  41 3-13
    PubMedGoogle Scholar
  • 23 Schwaiger M, Melin J. Cardiological applications of nuclear medicine.  Lancet. 1999;  354 661-666
    CrossrefPubMedGoogle Scholar
  • 24 Strauss H W, Miller D D, Wittry M D, Cerqueira M D, Garcia E V, Iskandrian A S, Schelbert H R, Wackers F J. Procedure guideline for myocardial perfusion imaging. Society of Nuclear Medicine.  J Nucl Med. 1998;  39 918-923
    PubMedGoogle Scholar
  • 25 Strauss H W. Comments on clarity, concision and consultation in nuclear medicine reports. A recipe to avoid the Tower of Babel and the ink of the cuttlefish.  Eur J Nucl Med. 1999;  26 789-790
    PubMedGoogle Scholar
  • 26 Trappe H J, Lollgen H. [Guidelines for ergometry. German Society of Cardiology - Heart and Cardiovascular Research].  Z Kardiol. 2000;  89 821-831
    CrossrefPubMedGoogle Scholar
  • 27 Udelson J E, Heller G V, Wackers F J, Chai A, Hinchman D, Coleman P S, Dilsizian V, DiCarli M, Hachamovitch R, Johnson J R, Barrett R J, Gibbons R J. Randomized, controlled dose-ranging study of the selective adenosine A2A receptor agonist binodenoson for pharmacological stress as an adjunct to myocardial perfusion imaging.  Circulation. 2004;  109 457-464
    CrossrefPubMedGoogle Scholar
  • 28 Underwood S R, Anagnostopoulos C, Cerqueira M, Ell P J, Flint E J, Harbinson M, Kelion A D, Al-Mohammad A, Prvulovich E M, Shaw L J, Tweddel A C. Myocardial perfusion scintigraphy: the evidenceA consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society, endorsed by the Royal College of Physicians of London and the Royal College of Radiologists.  Eur J Nucl Med Mol Imaging. 2003;  31 261-291
    PubMedGoogle Scholar
  • 29 Vallejo E, Dione D P, Sinusas A J, Wackers F J. Assessment of left ventricular ejection fraction with quantitative gated SPECT: accuracy and correlation with first-pass radionuclide angiography.  J Nucl Cardiol. 2000;  7 461-470
    CrossrefPubMedGoogle Scholar
  • 30 Varma S K, Watson D D, Beller G A. Quantitative comparison of thallium-201 scintigraphy after exercise and dipyridamole in coronary artery disease.  Am J Cardiol. 1989;  64 871-877
    CrossrefPubMedGoogle Scholar
  • 31 Wackers F J. Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) position statement on standardization and optimization of nuclear cardiology reports.  J Nucl Cardiol. 2000;  7 397-400
    CrossrefPubMedGoogle Scholar

Dr. med. Hubertus P. Bülow

Nuklearmedizinische Klinik und Poliklinik · Technische Universität München · Klinikum rechts der Isar

Ismaninger Str. 22

81675 München

Germany

Phone: +49-89-41 40-29 71

Fax: +49-89-41 40-49 50

Email: h.buelow@lrz.tu-muenchen.de

      >