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Der Nuklearmediziner 2004; 27(3): 208-212
DOI: 10.1055/s-2004-822725
Kardiologie aktuell

© Georg Thieme Verlag Stuttgart · New York

Die zukünftige Rolle von PET in der Kardiologie

Future Role of Cardiac PETP. A. Kaufmann1
  • 1Nuklear Kardiologie, Universitäts Spital Zürich, Schweiz
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Publication History

Publication Date:
16 September 2004 (online)

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Zusammenfassung

Die PET-Untersuchung mit F-18-Fluorodesoxyglukose hat sich als Goldstandard für die Vitalitätsdiagnostik mit hohem prognostischen Wert etabliert. Die Perfusionsuntersuchung mit N-13-Ammoniak ist der SPECT überlegen; die kurze Halbwertszeit von N-13-Ammoniak bedingt aber ein Zyklotron vor Ort, was bisher die verbreitete Anwendung verhindert hat. Die Quantifizierbarkeit der Perfusion erlaubt die Messung der koronaren Flussreserve, ein Maß für die koronare Mikrozirkulation, die bei Vorliegen von Risikofaktoren beeinträchtigt ist. Die Flussreserve kann als Zielgröße zur Kontrolle des funktionellen Erfolges einer Risikomodifikation verwendet werden.
Mit dem hybrid PET/CT Gerät bietet sich eine neue Perspektive in der nicht-invasiven Diagnostik dank gleichzeitiger Erfassung von Funktion (Perfusion) und Koronaranatomie. Allerdings dürfte die perfekte Fusion erst von entscheidender Bedeutung werden, wenn dank molekularer Bildgebung geeignete Liganden zur Identifizierung der vulnerable Plaque zur Verfügung stehen werden. Auch Verbindungen, die sich im hypoxischen Myokardgewebe anreichern, bergen das Potenzial für eine klinische Anwendung in der Zukunft.

Abstract

Scanning with F-18-fluorodesoxyglucose and PET for myocardial viability has been established as diagnostic and prognostic gold standard. Perfusion scan with N-13-ammonia is superior to SPECT scanning, but the need for a cyclotron has prevented its wide spread clinical use. The quantification of perfusion allows assessment of coronary flow reserve, an integrated index of coronary microcirculation, which is impaired in the presence of risk factors. Flow reserve can be used as target to monitor the functional effect of risk factor modification.
The use of hybrid PET/CT scanners provides a new perspective to non-invasive diagnostic allowing simultaneous assessment of function (perfusion) and coronary anatomy. The perfect fusion, however, will only be of added value when appropriate tracers will allow molecular imaging of the vulnerable plaque. In addition, further developments of ligands targeting hypoxic myocardial tissue may prove potentially clinical useful in the future.

Schlüsselwörter

PET - PET/CT - Endothelfunktion - molekulare Bildgebung

Key words

PET - PET/CT - endothelial function - molecular imaging

Literatur

  • 1 Allman K C, Shaw L J, Hachamovitch R. et al . Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis.  J Am Coll Cardiol. 2002;  39 1151-1158
    CrossrefPubMedGoogle Scholar
  • 2 Britz-Cunnningham S H, Adelstein S J. Molecular targeting with radionuclides: states of the science.  J Nucl Med. 2003;  44 1945-1961
    PubMedGoogle Scholar
  • 3 Czernin J, Barnard R J, Sun K T. et al . Effect of short-term cardiovascular conditioning and low-fat diet on myocardial blood flow and flow reserve.  Circulation. 1995;  92 197-204
    PubMedGoogle Scholar
  • 4 Demer L L, Gould K L, Goldstein R A. et al . Noninvasive assessment of coronary collaterals in man by PET perfusion imaging.  J Nucl Med. 1990;  31 259-270
    PubMedGoogle Scholar
  • 5 Demer L L, Gould K L, Goldstein R A. et al . Assessment of coronary artery disease severity by positron emission tomography. Comparison with quantitative arteriography in 193 patients.  Circulation. 1989;  79 825-835
    PubMedGoogle Scholar
  • 6 Di Carli M F, Asgarzadie F, Schelbert H R. et al . Quantitative relation between myocardial viability and improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy.  Circulation. 1995;  92 3436-3444
    PubMedGoogle Scholar
  • 7 Galbraith J E, Murphy M L, Desoyza N. Coronary angiogram interpretation: interobserver variability.  JAMA. 1981;  240 2053-2059
    PubMedGoogle Scholar
  • 8 Gimelli A, Schneider-Eicke J, Neglia D. et al . Homogeneously reduced versus regionally impaired myocardial blood flow in hypertensive patients: two different patterns of myocardial perfusion associated with degree of hypertrophy.  J Am Coll Cardiol. 1998;  31 366-373
    PubMedGoogle Scholar
  • 9 Go R T, Marwick T H, MacIntyre W J. et al . A prospective comparison of rubidium-82 PET and thallium-201 SPECT myocardial perfusion imaging utilizing a single dipyridamole stress in the diagnosis of coronary artery disease [see comments].  J Nucl Med. 1990;  31 1899-1905
    PubMedGoogle Scholar
  • 10 Goldstein R A, Kirkeeide R L, Smalling R W. et al . Changes in myocardial perfusion reserve after PTCA: noninvasive assessment with positron tomography.  J Nucl Med. 1987;  28 1262-1267
    PubMedGoogle Scholar
  • 11 Gould K L, Lipscomb K, Hamilton G W. Physiologic basis for assessing critical coronary stenosis.  Am J Cardiol. 1974;  33 87-92
    CrossrefPubMedGoogle Scholar
  • 12 Gould K L, Martucci J P, Goldberg D I. et al . Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease.  Circulation. 1994;  89 1530-1538
    PubMedGoogle Scholar
  • 13 Gould K L, Ornish D, Scherwitz L. et al . Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification.  Jama. 1995;  274 894-901
    CrossrefPubMedGoogle Scholar
  • 14 Grover-McKay M, Ratib O, Schwaiger M. et al . Detection of coronary artery disease with positron emission tomography and rubidium-82.  Am Heart J. 1992;  123 646-652
    CrossrefPubMedGoogle Scholar
  • 15 Guethlin M, Kasel A M, Coppenrath K. et al . Delayed response of myocardial flow reserve to lipid-lowering therapy with fluvastatin.  Circulation. 1999;  99 475-481
    PubMedGoogle Scholar
  • 16 Kaufmann P, Matter C, Mandinov L. et al . High level of cholesterol increases coronary vasomotor tone during exercise.  Coron Artery Dis. 2000;  11 459-466
    CrossrefPubMedGoogle Scholar
  • 17 Kaufmann P A, Frielingsdorf J, Mandinov L. et al . Reversal of abnormal coronary vasomotion by calcium antagonists in patients with hypercholesterolemia.  Circulation. 1998;  97 1348-1354
    PubMedGoogle Scholar
  • 18 Kaufmann P A, Gnecchi-Ruscone T, di Terlizzi M. et al . Coronary heart disease in smokers: Vitamin C restores coronary microcirculatory function.  Circulation. 2000;  102 1233-1238
    PubMedGoogle Scholar
  • 19 Kaufmann P A, Gnecchi-Ruscone T, Schafers K P. et al . Low density lipoprotein cholesterol and coronary microvascular dysfunction in hypercholesterolemia.  J Am Coll Cardiol. 2000;  36 103-109
    CrossrefPubMedGoogle Scholar
  • 20 Kjaer A, Meyer C, Nielsen F S. et al . Dipyridamole, cold pressor test, and demonstration of endothelial dysfunction: a PET study of myocardial perfusion in diabetes.  J Nucl Med. 2003;  44 19-23
    PubMedGoogle Scholar
  • 21 Klocke F J, Baird M G, Lorell B H. et al . 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
  • 22 Koepfli P, Hany T F, Wyss C A. et al . CT attenuation correction for myocardial perfusion quantification using a PET/CT hybrid scanner.  J Nucl Med. 2004;  45 537-542
    PubMedGoogle Scholar
  • 23 Muzik O, Duvernoy C, Beanlands R S. et al . Assessment of diagnostic performance of quantitative flow measurements in normal subjects and patients with angiographically documented coronary artery disease by means of nitrogen-13 ammonia and positron emission tomography.  J Am Coll Cardiol. 1998;  31 534-540
    CrossrefPubMedGoogle Scholar
  • 24 Namdar M, Hany T F, Burger C. et al . Combined computed tomography-angiogram and positron emission tomography perfusion Imaging for assessment of coronary artery disease in a novel PET/CT: A pilot feasibility study.  J Am Coll Cardiol. 2003;  41 (Suppl A) 439A
    PubMedGoogle Scholar
  • 25 Samady H, Elefteriades J A, Abbott B G. et al . Failure to improve left ventricular function after coronary revascularization for ischemic cardiomyopathy is not associated with worse outcome.  Circulation. 1999;  100 1298-1304
    PubMedGoogle Scholar
  • 26 Schelbert H R, Wisenberg G, Phelps M E. et al . Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilation. VI. Detection of coronary artery disease in human beings with intravenous N-13 ammonia and positron computed tomography.  Am J Cardiol. 1982;  49 1197-1207
    CrossrefPubMedGoogle Scholar
  • 27 Schindler T H, Nitzsche E U, Olschewski M. et al . Pressor testing correlate with indices of coronary vasomotion on quantitative coronary angiography.  J Nucl Med. 2004;  45 418-429
    PubMedGoogle Scholar
  • 28 Stewart R E, Schwaiger M, Molina E. et al . Comparison of rubidium-82 positron emission tomography and thallium-201 SPECT imaging for detection of coronary artery disease.  Am J Cardiol. 1991;  67 1303-1310
    CrossrefPubMedGoogle Scholar
  • 29 Tamaki N, Yonekura Y, Senda M. et al . Value and limitation of stress thallium-201 single photon emission computed tomography: comparison with nitrogen-13 ammonia positron tomography.  J Nucl Med. 1988;  29 1181-1188
    PubMedGoogle Scholar
  • 30 Vlodaver Z, Frech R, Van Tassel R A. et al . Correlation of the antemortem coronary arteriogram and the post mortem specimen.  Circulation. 1973;  47 162-169
    PubMedGoogle Scholar

Prof. Dr. med. Philipp A. Kaufmann

Universitäts Spital Zürich · C NUK 32

Rämistr. 100

8091 Zürich, Schweiz

Phone: +41-1-2 55-35 55

Fax: +41-1-2 55-44 14

Email: pak@usz.ch

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