¹⁸Fluor-FDG-SPECT zum Nachweis von hibernierendem Myokard: eine Zwischenbilanz FDG-SPECT and Hibernation: An Interim Review

Zusammenfassung

Ziel der vorliegenden Arbeit war ein intraindividueller Vergleich von FDG-PET und FDG-SPECT in der myokardialen Vitalitätsdiagnostik. Material und Methodik: Bei 30 Patienten mit KHK wurden vor Revas-kularisation beide Verfahren durchgeführt. Die Beurteilung der myokardialen Perfusion erfolgte mittels ^99mTc-MIBI SPECT. Die Resultate wurden von zwei erfahrenen Auswertern unter Verwendung einer 25-Segment-Einteilung des Myokards verglichen. Ergebnisse: Die segmentale Übereinstimmung zwischen PET und SPECT betrug 94,1 %. Die PET wies einen höheren Anteil hibernierendes Myokard aus (8,9% vs. 5,7%) und weniger Narbensegmente (11,5% vs. 16,0%). Die Indikation zur Revaskularisation wurde in 22 Fällen identisch beurteilt. Bei den übrigen 8 Untersuchungen sprach sechsmal die PET und zweimal die SPECT für eine Intervention. Schlußfolgerung: Einer hohen segmentalen Übereinstimmung stehen also erhebliche Unterschiede in der letztendlich entscheidenden klinischen Beurteilung der Untersuchungsergebnisse entgegen.

Summary

Aim: The present investigation demonstrates an intraindividual comparison of FDG-PET and FDG-SPECT. Material and Methods: Thirty patients with CHD and planed revascularisation underwent both modalities. Myocardial perfusion was evaluated by ^99mTc-MIBI SPECT. The myocardium was divided into 25 segments and the results were compared by two experienced observers. Results: Segmental concordance of FDG-PET and -SPECT was 94.1 %. PET indicated a higher percentage of hibernating myocardium (8.9% vs. 5.7%) and a lower rate of matched defects (11.5% vs. 16.0%). In 22 cases the need for revascularisation was assessed identically. In the remaining 8 patients FDG-PET and FDG-SPECT required an intervention in 6 and 2 cases, respectively. Conclusion: The results of FDG-PET and FDG-SPECT showed a high segmental concordance, but the individual assessment of hibernation worthwhile for revascularisation demonstrated important differences in patient management.

Schlüsselwörter

¹⁸Fluor-FDG - SPECT - myokardiale Vitalität

Keywords

¹⁸Fluor-FDG - SPECT - hibernating myocardium

• LITERATUR

• 1 Alexander C, Oberhausen E. Myocardial scintigraphy.. Sem Nucl Med 1995; 25: 195-201.
• 2 Bax JJ, Visser FC, van Lingen A, Huitink JM, Kamp O, van Leeuwen GR, Visser GWM, Teule GJJ, Visser CA. Feasibility of assessing regional myocardial uptake of ¹⁸F-fluorodeoxyglucose using single photon emission computed tomography.. Eur Heart J 1993; 14: 1675-82.
• 3 Berberich R, Hanser A, Schmidt EL, Stein-strässer A, Garth H. Myokardszintigraphie und Bestimmung der relativen Myokard-perfusion mit einem reinen Rb-81/Kr-81m-Gemisch.. In Radioaktive Isotope in Klinik und Forschung.. Höfer R, Bergmann H. (eds). Wien, Austria: Egermann; 1984. Bd. 16. Teil 1 215-8.
• 4 Britten AJ, Gane JN, Gill JS, Lowe CM, Joseph AEA.. Evaluation of dual isotope 511 keV and 140 keV SPECT imaging on a dual headed gamma camera.. Eur J Nucl Med 1995; 22: 809 (abstr).
• 5 Büll U, Foroutan Y, Hellwig D, Kaiser HJ, Schulz G, Sabri O, Schreckenberger M, Vom Dahl J. Vergleich von relativer ¹⁸FDG-Auf-nahme mit metabolischer Rate (MR Glukose) im Myokard bei KHK, klassifiziert mit ^99mTc-MIBI.. Nuklearmedizin 1995; 34: 223-8.
• 6 Burt RW, Perkins OW, Oppenheim BE, Schauwecker DS, Stein L, Wellman HN, Witt RM. Direct comparison of fluorine-18-FDG SPECT, fluorine-18-FDG PET and rest thallium-201 SPECT for detection of myocardial viability. J Nucl Med 1995; 36: 176-9.
• 7 Chaitman BR, Fisher LD, Bourassa MG. et al. Effect of coronary artery bypass surgery on survival patterns in subsets of patients with left main coronary artery disease: Report of the collaborative study in coronary artery surgery (CASS).. Am J Cardiol 1981; 48: 765-77.
• 8 Chen EQ, Maclntyre WJ, Go RT, Brunken RC, Saha GB, Wong CYO, Neumann DR, Cook SA, Khandekar S. Comparison of FDG myocardial viability studies using SPECT with two types of collimators and PET.. J Nucl Med 1996; 37: 177P (abstr).
• 9 Delbeke D, Videlefsky S, Patton JA, Campbell MG, Martin WH, Ohana I, Sandler MP. Rest myocardial perfusion/ metabolism imaging using simultaneous dual-isotope acquisition SPECT with tech-netium-99m-MIBI/fluorine-18-FDG. J Nucl Med 1995; 36: 2110-9.
• 10 DiCarli MF, Davidson M, Little R. et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction.. Am J Cardiol 1994; 73: 527-33.
• 11 Drane WE, Abbott FD, Nicole MW, Mastin ST, Kuperus JH. Technology for FDG SPECT with a relatively inexpensive gamma camera.. Radiology 1994; 191: 461-5.
• 12 Drane WE, Nicole MW, Mastin ST, Kuperus JH. SPECT with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG).. Radiology 1995; 197: 341-3.
• 13 Eitzman D, Al-Aouar Z, Kanter HL. et al. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography.. J Am Coll Cardiol 1992; 20: 559-65.
• 14 Hoflin F, Ledermann H, Noelpp U, Weinreich R, Rosler H. Routine ¹⁸F-2-deoxy-2-fluoro-D-glucose (¹⁸F-FDG) myocardial tomography using a normal large field of view gamma camera.. Angiology 1989; 40: 1058-164.
• 15 Maddahi J, Scheiben H, Brunken R, Di Carli M. Role of thallium-201 and PET Imaging in evaluation of myocardial viability and management of patients with coronary artery disease and left ventricular dysfunction.. J Nucl Med 1994; 35: 707-15.
• 16 Martin WH, Delbeke D, Patton JA, Hendrix B, Weinfeld Z, Ohana I, Kessler M, Sandler MP. FDG-SPECT: correlation with FDG-PET.. J Nucl Med 1995; 36: 988-95.
• 17 Miyaoka RS, Costa WLS, Lewellen TK, Kaplan MS, Kohlmyer SK, Jansen F. Coincidence mode imaging using a standard dual-headed gamma camera.. J Nucl Med 1996; 37: 223P (abstr).
• 18 Newiger H, Jordan K. Optimization of collimators for imaging positron emitters by a gamma camera.. Eur J Nucl Med 1985; 11: 230-4.
• 19 Oberhausen E, Berberich R, Ruth T, Ozbek C, Hellwig N. F-18-FDG-Szintigraphie mit einem Ein-Kopf-SPECT-System zur Erkennung von “hibernating myocardium” und von Lungentumoren.. In Radioaktive Isotope in Klinik und Forschung.. Höfer R, Bergmann H, Sinzinger H. (eds). Stuttgart; New York Schattauer: 1993: 87-90.
• 20 Patton JA, Forrester JW, Sandler MP.. Correction for downscatter from F-18 in DISA (FDG/MIBI) SPECT.. J Nucl Med 1996; 37: 31P (abstr).
• 21 Ritchie JL, Bateman TM, Bonow RO, Crawford MH, Gibbons RJ, Hall RJ, O’Rourke RA. et al. ACC/AHA Task force report: Guidelines for clinical use of cardiac radionuclide imaging.. JACC 1995; 25: 521-47.
• 22 Saha GB. (ed). Fundamentals of Nuclear Pharmacy - 3rd Edition.. Berlin, Heidelberg, New York: Springer; 1992
• 23 Schaefer A, Oberhausen E.. Testmessungen an der Multispect-2-Gammakamera zum Nachweis von 511-keV-Gammastrahlung.. Nuklearmedizin. 1995; 34: 40-6.
• 24 Schaefer A, Reiche W, Kirsch C-M, Piepgras U. Single photon emission computed tomography of brain tumours using ¹⁸fluoro-deoxyglucose: methodical aspects and first results.. Eur J Nucl Med 1995; 22: 809 (abstr).
• 25 Sorenson JA, Phelps ME. Physics in Nuclear Medicine.. London: WB Saunders; 1987
• 26 Srinivasan G, Kitsiou AN, Bacharach SL, Davis CM, Stewart-Henney PA, Dilsizian V. FDG cardiac SPECT versus PET: relation to SPECT radionuclide angiography and thallium scintigraphy.. J Nucl Med 1996; 37: 60P (abstr).
• 27 Stoll HP, Hellwig N, Alexander C, Özbek C, Schieffer H, Oberhausen E. Myocardial metabolic imaging by means of fluorine-18 deoxyglucose/technetium-99m sestamibi dual-isotope single-photon emission tomography.. Eur J Nucl Med 1994; 21: 1085-93.
• 28 The Multicentre Postinfarction Research Group.. Risk stratification and survival after myocardial infarction.. N Engl J Med 1983; 309: 331-9.
• 29 Valkema R, Poldermans D, Reijs AEM, van Peski J, Rambaldi R, Fioretti PM, Krenning EP. Evaluation of myocardial viability using dual isotope simultaneous acquisition (DISA) with Tc-99m-Tetrofosmin and 18-FDG and a three-head SPECT camera.. J Nucl Med 1996; 37: 60P (abstr).
• 30 Wienhard K, Wagner R, Heiss WD. (eds). PET Grundlagen und Anwendungen der Positronen-Emissions-Tomographie.. Berlin, Heidelberg, New York: Springer; 1989