REVIEW ARTICLES  SINGLE PHOTON EMISSION TOMOGRAPHY 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2005 June;49(2):193-203

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

SPET in cardiology. Diagnosis, prognosis, and management of patients with coronary artery disease

Tamaki N., Morita K.

Department of Nuclear Medicine Hokkaido University School of Medicine, Sapporo, Japan

Stress myo­car­dial per­fu­sion imag­ing has ­been con­sid­ered as a ­most val­u­able ­means for diag­no­sis and treat­ment strat­e­gy in ­patients ­with sus­pect­ed and ­known cor­o­nary ­artery dis­ease. 99mTc per­fu­sion imag­ing ­agents pro­vide excel­lent myo­car­dial per­fu­sion imag­es. In addi­tion, great­er pho­ton ­flux ­from the trac­er per­mits simul­ta­ne­ous assess­ment of region­al per­fu­sion and func­tion ­with use ECG-gat­ed acqui­si­tion. Gated ­SPET imag­ing tech­nique has a poten­tial for high­er diag­nos­tic accu­ra­cy for diag­no­sis of cor­o­nary ­artery dis­ease and assess­ment of the dis­ease sever­ity. In addi­tion, radio­nu­clide imag­ing ­plays an impor­tant ­role to dif­fer­en­tiate rever­sible ischem­ic myo­car­di­um ­which may ­improve LV func­tion ­after revas­cu­lar­iza­tion ­from irre­ver­sible ­scar in ­patients ­with his­to­ry of myo­car­dial infarc­tion. While FDG-PET is con­sid­ered as a ­most reli­able ­means for myo­car­dial assess­ment, ­SPET imag­ing has ­been wide­ly ­used for the viabil­ity assess­ment, ­with gain­ing high­er accu­ra­cy for pre­dict­ing rever­sible ische­mia. Recently a varie­ty of new radio­phar­ma­ceu­ti­cal ­agents ­have ­been intro­duced to ­probe myo­car­dial func­tion in ­vivo. [123I]­BMIPP, a ­branched fat­ty ­acid ana­log, has ­been ­used for meta­bol­ic imag­ing ­using ­SPET. Less ­uptake of ­BMIPP ­than per­fu­sion is ­often ­observed in the ischem­ic myo­car­di­um. Such a per­fu­sion meta­bol­ic mis­match ­which ­seems to be sim­i­lar­ly ­observed in FDG-PET is iden­ti­fied in the ­stunned or hiber­nat­ing myo­car­di­um ­with region­al dys­func­tion. Severe ische­mia is iden­ti­fied as ­reduced ­BMIPP ­uptake at ­rest, sug­gest­ing its ­role as an ischem­ic mem­o­ry imag­ing. These new tech­niques ­will pro­vide ­insights ­into new path­o­log­i­cal ­states in the ischem­ic ­heart dis­ease and ­enable to ­select opti­mal treat­ment of ­these ­patients.