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Der Nuklearmediziner 2015; 38(01): 24-33
DOI: 10.1055/s-0034-1396828
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© Georg Thieme Verlag KG Stuttgart · New York

Der Normalbefund in der Myokard-Perfusions-Szintigrafie

The Normal Myocardial Perfusion Scan: Characteristics and Value
O. Lindner
1   Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum
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Publication History

Publication Date:
10 March 2015 (online)

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Zusammenfassung

Die Kenntnis des normalen Befunds ist Voraussetzung für das Erkennen des pathologischen Befunds. In der Myokard-Perfusions-Szintigrafie haben sich neben der subjektiven visuellen Interpretation objektivierbare Parameter etabliert, die die Diagnose „Normalbefund“ erhärten können. Für die Perfusions-SPECT ist das in erster Linie der Summed Stress Score und für die ergänzende Funktionsanalyse (gated SPECT) die linksventrikuläre Ejektionsfraktion (LVEF) einschließlich der Ventrikelvolumina. Liegen diese Parameter innerhalb ihrer Normbereiche, ist aus prognostischer Sicht das kardiale Risiko des Patienten nicht erhöht und aus koronarmorphologischer Sicht von keiner funktionell relevanten Stenose auszugehen.

Bei einem Normalbefund unter adäquater Belastung erübrigt sich die Durchführung einer Ruhe-Myokard-Perfusions-SPECT. Somit kann bei einem normalgewichtigen Patienten mit einer Dosis von nur 2 mSv eine relevante KHK ausgeschlossen werden und durch den Verzicht auf die Ruheuntersuchung ein signifikanter Beitrag zum individuellen Strahlenschutz erfolgen.

Abstract

The knowledge of a normal myocardial perfusion scan constitutes a precondition to recognise pathological results. Beyond the subjective visual interpretation of a scan, several objective parameters have been established in myocardial perfusion imaging which determine a normal scan result. These are the summed stress score in perfusion SPECT imaging and the LVEF combined with the ventricular volumes in gated SPECT. If these particular items are within their normal ranges, the individual cardiac risk of a patient is low. Considering morphology of the coronaries no functionally relevant stenosis is present.

In case of a normal scan result under adequate stress, the rest scan can be omitted. This decision path is an effective method to reduce effectively individual radiation exposure and to exclude a significant coronary artery disease with a dose of only 2 mSv in a normal weight patient.

Schlüsselwörter

Myokard-Perfusions-Szintigrafie - Normalbefund - Risikobeurteilung - Prognose

Key words

myocardial perfusion scintigraphy - normal scan result - risk assessment - prognosis
 

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