Myokardszintigrafie: aktueller Stand

Zusammenfassung

Die Myokard-Einzelphotonen-Emissionscomputertomografie (Myokard-SPECT) ist ein seit mehreren Jahrzehnten gut etabliertes und validiertes Verfahren zur Detektion einer hämodynamisch relevanten koronaren Herzkrankheit (KHK). Aktuell ist es das am häufigsten eingesetzte nicht invasive diagnostische Untersuchungsverfahren zur Ischämiediagnostik. Mit einer Sensitivität und Spezifität von jeweils 80–90% ist die diagnostische Genauigkeit vergleichbar zur Stress-Echokardiografie oder Stress-MR-Tomografie. Die Einführung der Technetium-Tracer sowie der EKG-Triggerung und der Abschwächungskorrektur hat insbesondere die Spezifität nochmals deutlich verbessert. Hohe Kameraempfindlichkeiten sowie schnelle Datenakquisitionsprotokolle haben sowohl die Untersuchungsdauer als auch die Strahlenbelastung signifikant reduzieren können. Hervorzuheben ist die weitgehende Untersucherunabhängigkeit durch validierte und reproduzierbare Computeralgorithmen bei der Datenauswertung. Große prospektive und retrospektive Analysen haben den hohen prognostischen Wert in allen Stadien der KHK (Vorfelddiagnostik, Postinfarktphase, Einschätzung der hämodynamischen Relevanz einer angiografisch gesicherten Stenose, Therapiebeurteilung nach PCI oder ACB-Operation) eindrucksvoll demonstriert. Die Kombination mit morphologisch ausgerichteten nicht invasiven bildgebenden Verfahren (Hybridbildgebung in Kombination mit der CT-Koronarangiografie, SPECT‑CT) stellt möglicherweise die nicht invasive Diagnostik der KHK der Zukunft dar, sofern kostenmäßig realisierbar.

Abstract

Nuclear myocardial perfusion imaging using single photon emission computed tomography (SPECT) in combination with various tracers is for many years the most widely used technology for the non-invasive detection of hemodynamically significant coronary artery disease (CAD). Sensitivity and specificity range between 80 and 90% and are comparable to stress echocardiography and stress MR-imaging. Combining SPECT with technetium 99m tracers and using modern technologies such as ECG-triggering and soft tissue attenuation correction algorithms have further significantly improved the diagnostic accuracy. Modern cameras in combination with fast data acquisition have reduced the imaging times as well as radiation exposure of the patient. Semi-automated analysis software has improved reproducibility and validity of data analysis. Several large retrospective aswell as prospective studies have demonstrated the prognostic value of SPECT perfusion imaging in all stages of CAD. Hybrid imaging using SPECT technology in combination with CT coronary angiography may further improve and fasten the diagnostic work-up of patients with suspected CAD and may reduce the need for overall diagnostic coronary angiography but may also lead to higher proportion of coronary angiography subsequently followed by necessary and indicated coronary revascularization.

Schlüsselwörter

Myokardperfusion - Nuklearmedizin - Prognose - SPECT - Ischämie - koronare Herzkrankheit

Key words

myocardial perfusion - nuclear imaging - prognosis - SPECT - ischemia - coronary artery disease

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