Nuklearkardiologie up2date

Dieser Artikel soll einen Überblick über den klinischen Stellenwert der wichtigsten nuklearkardiologischen Verfahren bieten und besonders auf die leitliniengerechte Indikationsstellung und Besonderheiten der methodischen Durchführung und Befundung eingehen. Im Fokus stehen dabei die Myokardperfusionsszintigraphie im Kontext der aktuellen ESC-Richtlinien, die Szintigraphie in der kardialen Amyloidose-Abklärung und die Positronenemissionstomographie in der Diagnostik der infektiösen Endokarditis.

Publication History

Article published online:
08 December 2025

• Literatur

• 1 Vrints C, Andreotti F, Koskinas KC. et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024; 45: 3415-3537
• 2 Kiso K, Masuda A, Takanami K. et al. Post-ISCHEMIA Trial Era: Reconsideration of the Role of Nuclear Cardiology in Patients with Chronic Coronary Artery Disease. Ann Nucl Cardiol 2022; 8: 86-90
• 3 Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN). Update: S1-Leitlinie Myokard-Perfusions-SPECT. Nuklearmedizin 2017; 56: N26
• 4 Lindner O, Hacker M, Burchert W. et al. SPECT and PET myocardial perfusion imaging in Austria, Germany, and Switzerland results of the first joint survey of 2021. Eur J Nucl Med Mol Imaging 2023; 50: 3602-3608
• 5 Verberne HJ, Acampa W, Anagnostopoulos C. et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015; 42: 1929-40
• 6 Dorbala S, Ananthasubramaniam K, Armstrong IS. et al. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol 2018; 25: 1784-1846
• 7 Hyafil F, Gimelli A, Slart RHJA. et al. EANM procedural guidelines for myocardial perfusion scintigraphy using cardiac-centered gamma cameras. Eur J Hybrid Imaging 2019; 3: 11
• 8 Qiu L, Tan H, Cheng D. et al. The incremental clinical value of cardiac hybrid SPECT/CTA imaging in coronary artery disease. Nucl Med Commun 2018; 39: 469-478
• 9 Boden WE, O'Rourke RA, Teo KK. et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356: 1503-16
• 10 Maron DJ, Hochman JS, Reynolds HR. et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med 2020; 382: 1395-1407
• 11 Sharir T, Germano G, Kang X. et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. J Nucl Med 2001; 42: 831-7
• 12 McLaughlin MG, Danias PG. Transient ischemic dilation: a powerful diagnostic and prognostic finding of stress myocardial perfusion imaging. J Nucl Cardiol 2002; 9: 663-7
• 13 Hu LH, Sharir T, Miller RJH. et al. Upper reference limits of transient ischemic dilation ratio for different protocols on new-generation cadmium zinc telluride cameras: A report from REFINE SPECT registry. J Nucl Cardiol 2020; 27: 1180-1189
• 14 Agostini D, Roule V, Nganoa K. et al. First validation of myocardial flow reserve assessed by dynamic ^99mTc-sestamibi CZT-SPECT camera: head to head comparison with ¹⁵O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging 2018; 45: 1079-1090
• 15 de Souza ACDA, Gonçalves BKD, Tedeschi AL. et al. Quantification of myocardial flow reserve using a gamma camera with solid-state cadmium-zinc-telluride detectors: Relation to angiographic coronary artery disease. J Nucl Cardiol 2021; 28: 876-884
• 16 Keam SJ. Flurpiridaz F 18: First Approval. Am J Cardiovasc Drugs 2025; 25: 1-6
• 17 Motwani M, Leslie WD, Goertzen AL. et al. Fully automated analysis of attenuation-corrected SPECT for the long-term prediction of acute myocardial infarction. J Nucl Cardiol 2018; 25: 1353-1360
• 18 Alskaf E, Dutta U, Scannell CM. et al. Deep learning applications in myocardial perfusion imaging, a systematic review and meta-analysis. Inform Med Unlocked 2022; 32: 101055
• 19 de Souza Filho EM, de Amorim Fernandes F, Wiefels C. et al. Machine Learning Algorithms to Distinguish Myocardial Perfusion SPECT Polar Maps. Front Cardiovasc Med 2021; 8: 741667
• 20 Betancur J, Commandeur F, Motlagh M. et al. Deep Learning for Prediction of Obstructive Disease From Fast Myocardial Perfusion SPECT: A Multicenter Study. JACC Cardiovasc Imaging 2018; 11: 1654-1663
• 21 Miller RJH, Slomka PJ. Artificial Intelligence in Nuclear Cardiology: An Update and Future Trends. Semin Nucl Med 2024; 54: 648-657
• 22 Arbelo E, Protonotarios A, Gimeno JR. et al. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44: 3503-3626
• 23 Dorbala S, Ando Y, Bokhari S. et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging. Circ Cardiovasc Imaging 2021; 14: e000029
• 24 Gillmore JD, Maurer MS, Falk RH. et al. Nonbiopsy Diagnosis of Cardiac Transthyretin Amyloidosis. Circulation 2016; 133: 2404-12
• 25 Rettl R, Wollenweber T, Duca F. et al. Monitoring tafamidis treatment with quantitative SPECT/CT in transthyretin amyloid cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24: 1019-1030
• 26 Kim SH, Kim YS, Kim SJ. Diagnostic performance of PET for detection of cardiac amyloidosis: A systematic review and meta-analysis. J Cardiol 2020; 76: 618-625
• 27 Spielvogel CP, Haberl D, Mascherbauer K. et al. Diagnosis and prognosis of abnormal cardiac scintigraphy uptake suggestive of cardiac amyloidosis using artificial intelligence: a retrospective, international, multicentre, cross-tracer development and validation study. Lancet Digit Health 2024; 6: e251-e260
• 28 Delgado V, Marsan NA, de Waha S. et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44: 3948-4042
• 29 Abikhzer G, Treglia G, Pelletier-Galarneau M. et al. EANM/SNMMI guideline/procedure standard for [18F]FDG hybrid PET use in infection and inflammation in adults v2.0. Eur J Nucl Med Mol Imaging.. 2025; 52: 510-538
• 30 Ten Hove D, Slart RHJA, Sinha B. et al. F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization. Curr Cardiol Rep 2021; 23: 130
• 31 Erba PA, Lancellotti P, Vilacosta I. et al. Recommendations on nuclear and multimodality imaging in IE and CIED infections. Eur J Nucl Med Mol Imaging 2018; 45: 1795-1815
• 32 Roll W, Faust A, Hermann S. et al. Infection Imaging: Focus on New Tracers?. J Nucl Med 2023; 64 (Suppl. 02) 59S-67S