Download PDF
Nuklearmedizin 2013; 52(02): 51-63
DOI: 10.3413/Nukmed-0550-12-12
Handlungsempfehlung
Schattauer GmbH

Myokard-Perfusions-Szintigraphie

Kurzfassung der S1-LeitlinieMyocardial perfusion scintigraphyshort form of the German guideline
O. Lindner
1   Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen
,
W. Burchert
1   Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen
,
M. Hacker
2   Klinik und Poliklinik für Nuklearmedizin, Ludwig Maximilians Universität München
,
W. Schaefer
3   Klinik für Nuklearmedizin, Kliniken Maria Hilf GmbH, Mönchengladbach
,
M. Schmidt
4   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln
,
O. Schober
5   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Münster
,
M. Schwaiger
6   Nuklearmedizinische Klinik, Klinikum rechts der Isar, Technische Universität München
,
J. vom Dahl
7   Klinik für Kardiologie, Kliniken Maria Hilf GmbH, Mönchengladbach
,
R. Zimmermann
8   Medizinische Klinik, Klinikum Pforzheim GmbH, Pforzheim
,
M. Schäfers
9   European Institute of Molecular Imaging, Westfälische Wilhelms Universität Münster
› Author Affiliations
Further Information

Publication History

received: 11 December 2012

accepted in revised form: 08 January 2013

Publication Date:
30 December 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Diese Leitlinie ist die Kurzfassung der bei der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) publizierten Leitlinie zur Myokard-Perfusions-Szintigraphie. Sie soll eine praxisorientierte Hilfestellung zur Indikation, Durchführung und Auswertung der Myokard-Perfusions-Szintigraphie geben und den aktuellen Stand des Verfahrens darstellen.

Nach der Einführung in die Grundlagen folgen konkrete und detaillierte Angaben zur Indikationsstellung, zur Untersuchungsvorbereitung, zu Belastungsverfahren, Radiopharmaka, Akquisitionsprotokollen und -techniken, Strahlenexposition, Datenrekonstruktion sowie zur visuellen und quantitativen Bildanalyse und -interpretation. Zusätzlich werden Fehlerquellen behandelt und Grundelemente des Befundberichtes aufgezeigt.

Summary

This guideline is a short summary of the guideline for myocardial perfusion scintigraphy published by the Association of the Scientific Medical Societies in Germany (AWMF). The purpose of this guideline is to provide practical assistance for indication and examination procedures as well as image analysis and to present the state-ofthe-art of myocardial-perfusion-scintigraphy. After a short introduction on the fundamentals of imaging, precise and detailed information is given on the indications, patient preparation, stress testing, radiopharmaceuticals, examination protocols and techniques, radiation exposure, data reconstruction as well as information on visual and quantitative image analysis and interpretation. In addition possible pitfalls, artefacts and key elements of reporting are described.

Schlüsselwörter

Myokard-Perfusions-Szintigraphie

Keywords

Myocardial perfusion scintigraphy
 

  • Literatur

  • 1 Acampa W, Cuocolo A, Petretta M. et al. Tetrofosmin imaging in the detection of myocardial viability in patients with previous myocardial infarction: comparison with sestamibi and Tl-201 scintigraphy. J Nucl Cardiol 2002; 9: 33-40.
    CrossrefPubMedGoogle Scholar
  • 2 Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. 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
  • 3 Anderson JL, Adams CD, Antman EM. et al. ACC/ AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction. Circulation 2007; 116: e148-e304.
    CrossrefPubMedGoogle Scholar
  • 4 Bateman TM, Heller GV, Johnson LL. et al. Does attenuation correction add value to non-attenu-ation corrected ECG-gated technetium-99m-sestamibi SPECT?. J Nucl Cardiol 2003; 10: S91.
    Google Scholar
  • 5 Bax JJ, Wijns W, Cornel JH. et al. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: comparison of pooled data. J Am Coll Cardiol 1997; 30: 1451-1460.
    CrossrefPubMedGoogle Scholar
  • 6 Berman DS, Abidov A, Kang X. et al. Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol 2004; 11: 414-423.
    CrossrefPubMedGoogle Scholar
  • 7 Biagini E, Shaw LJ, Poldermans D. et al. Accuracy of non-invasive techniques for diagnosis of coronary artery disease and prediction of cardiac events in patients with left bundle branch block: a metaanalysis. Eur J Nucl Med Mol Imaging 2006; 33: 1442-1451.
    CrossrefPubMedGoogle Scholar
  • 8 Bottcher M, Czernin J, Sun KT. et al. Effect of caffeine on myocardial blood flow at rest and during pharmacological vasodilation. J Nucl Med 1995; 36: 2016-2021.
    PubMedGoogle Scholar
  • 9 Bundesamt fur Strahlenschutz. Bekanntmachung der diagnostischen Referenzwerte für radiologische und nuklearmedizinische Untersuchungen. 10. Juli 2003.
  • 10 Bundesärztekammer, Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften, Kassenarztliche Bundesvereinigung. Nationale Versorgungs-Leitlinie Chronische KHK, Version 1.10 (Langfassung). Dezember 2010. www.versorgungsleitlinien.de/themen/khk/pdf/nvl_khk_lang.pdf (letzter Zugriff 23.05.2011).
    Google Scholar
  • 11 Cerqueira MD, Weissman NJ, Dilsizian V. et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 2002; 18: 539-542.
    PubMedGoogle Scholar
  • 12 Del Val Gomez M, Gallardo FG, San Martin MA, Garcia A, Terol I. Ischaemic related transitory left ventricular dysfunction in 201Tl gated SPECT. Nucl Med Commun 2005; 26: 601-605.
    CrossrefPubMedGoogle Scholar
  • 13 Douglas PS, Hendel RC, Cummings JE. et al. ACCF/ACR/AHA/ASE/ASNC/HRS/NASCI/ RSNA/SAIP/SCAI/SCCT/SCMR 2008 Health Policy Statement on Structured Reporting in Cardiovascular Imaging. Circulation 2009; 119: 187-200.
    CrossrefPubMedGoogle Scholar
  • 14 Druz RS, Akinboboye OA, Grimson R. et al. Postischemic stunning after adenosine vasodilator stress. J Nucl Cardiol 2004; 11: 534-541.
    CrossrefPubMedGoogle Scholar
  • 15 Fricke E, Esdorn E, Kammeier A. et al. Respiratory resistance of patients during cardiac stress testing with adenosine: is dyspnea a sign of bronchospasm?. J Nucl Cardiol 2008; 15: 94-99.
    CrossrefPubMedGoogle Scholar
  • 16 Germano G, Berman D. Acquisition and Processing for Gated Perfusion SPECT: Technical Aspects. Germano G, Berman D. Clinical Gated Cardiac SPECT.. Armonk, New York: Futura Publishing Company, Inc.; 1999: 93-113.
    Google Scholar
  • 17 Gibbons RJ, Balady GJ, Bricker JT. et al. ACC/AHA 2002 guideline update for exercise testing: summary article. J Am Coll Cardiol 2002; 40: 1531-1540.
    CrossrefPubMedGoogle Scholar
  • 18 Giorgetti A, Rossi M, Stanislao M. et al. Feasibility and diagnostic accuracy of a gated SPECT early-imaging protocol: a multicenter study of the Myo-view Imaging Optimization Group. J Nucl Med 2007; 48: 1670-1675.
    CrossrefPubMedGoogle Scholar
  • 19 Hachamovitch R, Berman DS. The use of nuclear cardiology in clinical decision making. Semin Nucl Med 2005; 35: 62-72.
    CrossrefPubMedGoogle Scholar
  • 20 Hachamovitch R, Berman DS, Shaw LJ. et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998; 97: 535-543.
    CrossrefPubMedGoogle Scholar
  • 21 Hachamovitch R, Hayes SW, Friedman JD. et al. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003; 107: 2900-2907.
    CrossrefPubMedGoogle Scholar
  • 22 Hachamovitch R, Rozanski A, Hayes SW. et al. Predicting therapeutic benefit from myocardial revascularization procedures: are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary?. J Nucl Cardiol 2006; 13: 768-778.
    CrossrefPubMedGoogle Scholar
  • 23 Hage FG, Venkataraman R, Aljaroudi W. et al. The impact of viability assessment using myocardial perfusion imaging on patient management and outcome. J Nucl Cardiol 2010; 17: 378-389.
    CrossrefPubMedGoogle Scholar
  • 24 Hansen CL, Goldstein RA, Berman DS. et al. Myocardial perfusion and function single photon emission computed tomography. J Nucl Cardiol 2006; 13: e97-e120.
    CrossrefPubMedGoogle Scholar
  • 25 Hara M, Monzen H, Futai R. et al. Reduction of infracardiac intestinal activity by a small amount of soda water in technetium-99m tetrofosmin myocardial perfusion scintigraphy with adenosine stress. J Nucl Cardiol 2008; 15: 241-245.
    CrossrefPubMedGoogle Scholar
  • 26 Hashimoto A, Palmar EL, Scott JA. et al. Complications of exercise and pharmacologic stress tests: differences in younger and elderly patients. J Nucl Cardiol 1999; 6: 612-619.
    CrossrefPubMedGoogle Scholar
  • 27 Hashimoto J, Kubo A, Iwasaki R. et al. Gated single-photon emission tomography imaging protocol to evaluate myocardial stunning after exercise. Eur J Nucl Med 1999; 26: 1541-1546.
    CrossrefPubMedGoogle Scholar
  • 28 Hendel RC, Berman DS, Di Carli MF. et al. ACCF/ ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging. Circulation 2009; 119: e561-e587.
    CrossrefPubMedGoogle Scholar
  • 29 Hendel RC, Budoff MJ, Cardella JF. et al. ACC/ AHA/ACR/ASE/ASNC/HRS/NASCI/RSNA/ SAIP/SCAI/ SCCT/SCMR/SIR 2008 Key Data Elements and Definitions for Cardiac Imaging: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Data Standards. Circulation 2009; 119: 154-186.
    CrossrefPubMedGoogle Scholar
  • 30 Hendel RC, Corbett JR, Cullom SJ. et al. The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine. J Nucl Cardiol 2002; 9: 135-143.
    CrossrefPubMedGoogle Scholar
  • 31 Hesse B, Tagil K, Cuocolo A. et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005; 32: 855-897.
    CrossrefPubMedGoogle Scholar
  • 32 Holly TA, Abbott BG, Al-Mallah M. et al. Single photon-emission computed tomography. J Nucl Cardiol 2010; 17: 941-973.
    CrossrefPubMedGoogle Scholar
  • 33 ICRP. Publication 80. Radiological protection in biomedical research: Annals of the ICRP Vol 28/3. Pergamon Press; 1998
  • 34 Iskandrian AE, Bateman TM, Belardinelli L. et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007; 14: 645-658.
    CrossrefPubMedGoogle Scholar
  • 35 Klocke FJ, Baird MG, Lorell BH. et al. ACC/AHA/ ASNC guidelines for the clinical use of cardiac radionuclide imaging - executive summary. Circulation 2003; 108: 1404-1418.
    CrossrefPubMedGoogle Scholar
  • 36 Knapp WH. Guidelines for myocardial perfusion scintigraphy. Nuklearmedizin 1999; 38: 226-229.
    PubMedGoogle Scholar
  • 37 Leaker BR, O’Connor B, Hansel TT. et al. Safety of regadenoson, an adenosine A2A receptor agonist for myocardial perfusion imaging, in mild asthma and moderate asthma patients: a randomized, double-blind, placebo-controlled trial. J Nucl Cardiol 2008; 15: 329-336.
    CrossrefPubMedGoogle Scholar
  • 38 Lindner O, Burchert W, Bengel FM. et al. Myocardial perfusion scintigraphy 2008 in Germany - results of the fourth query. Nuklearmedizin 2010; 49: 65-72.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 McLaughlin MG, Danias PG. Transient ischemic dilation: a powerful diagnostic and prognostic finding of stress myocardial perfusion imaging. J Nucl Cardiol 2002; 9: 663-667.
    CrossrefPubMedGoogle Scholar
  • 40 McNeill AJ, Fioretti PM, el-Said SM. et al. Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography. Am J Cardiol 1992; 70: 41-46.
    CrossrefPubMedGoogle Scholar
  • 41 Navare SM, Mather JF, Shaw LJ. et al. Comparison of risk stratification with pharmacologic and exercise stress myocardial perfusion imaging: a metaanalysis. J Nucl Cardiol 2004; 11: 551-561.
    CrossrefPubMedGoogle Scholar
  • 42 Notghi A, Williams N, Smith N. et al. Relationship between myocardial counts and patient weight: adjusting the injected activity in myocardial perfusion scans. Nucl Med Commun 2003; 24: 55-59.
    CrossrefPubMedGoogle Scholar
  • 43 O'Keefe Jr JH, Bateman TM, Barnhart CS. Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block. J Am Coll Cardiol 1993; 21: 1332-1338.
    CrossrefPubMedGoogle Scholar
  • 44 Pennell DJ, Mavrogeni SI, Forbat SM. et al. Adenosine combined with dynamic exercise for myocardial perfusion imaging. J Am Coll Cardiol 1995; 25: 1300-1309.
    CrossrefPubMedGoogle Scholar
  • 45 Pereztol-Valdes O, Candell-Riera J, Santana-Boado C. et al. Correspondence between left ventricular 17 myocardial segments and coronary arteries. Eur Heart J 2005; 26: 2637-2643.
    CrossrefPubMedGoogle Scholar
  • 46 Preuss R, Weise R, Lindner O. et al. Optimisation of protocol for low dose CTderived attenuation correction in myocardial perfusion SPECT imaging. Eur J Nucl Med Mol Imaging 2008; 35: 1133-1141.
    CrossrefPubMedGoogle Scholar
  • 47 Reyes E, Stirrup J, Roughton M. et al. Attenuation of adenosine-induced myocardial perfusion heterogeneity by atenolol and other cardioselective betaadrenoceptor blockers: a crossover myocardial perfusion imaging study. J Nucl Med 2010; 51: 1036-1043.
    CrossrefPubMedGoogle Scholar
  • 48 Schäfers M, Bengel F, Büll U. et al. Positionspapier Nuklearkardiologie. Kardiologe 2009; 3: 283-289.
    CrossrefGoogle Scholar
  • 49 Seifert H, Chapot C, Schaefer A. et al. Radiation exposure of the patient caused by transmission measurement for myocardial perfusion SPECT. Nuklearmedizin 1999; 38: 186-188.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Sharir T, Bacher-Stier C, Dhar S. et al. Identification of severe and extensive coronary artery disease by postexercise regional wall motion abnormalities in Tc-99m sestamibi gated single-photon emission computed tomography. Am J Cardiol 2000; 86: 1171-1175.
    CrossrefPubMedGoogle Scholar
  • 51 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: 831-837.
    PubMedGoogle Scholar
  • 52 Sharir T, Kang X, Germano G. et al. Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: gender-related differences in normal limits and outcomes. J Nucl Cardiol 2006; 13: 495-506.
    CrossrefPubMedGoogle Scholar
  • 53 Sharples L, Hughes V, Crean A. et al. Cost-effectiveness of functional cardiac testing in the diagnosis and management of coronary artery disease: a randomised controlled trial. The CECaT trial. Health Technol Assess 2007; 11: iii-iv ix-115.
    CrossrefPubMedGoogle Scholar
  • 54 Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 2004; 11: 171-185.
    CrossrefPubMedGoogle Scholar
  • 55 Smits P, Corstens FH, Aengevaeren WR. et al. False-negative dipyridamole-thallium-201 myocardial imaging after caffeine infusion. J Nucl Med 1991; 32: 1538-1541.
    PubMedGoogle Scholar
  • 56 Smits P, Lenders JW, Thien T. Caffeine and theophylline attenuate adenosineinduced vasodilation in humans. Clin Pharmacol Ther 1990; 48: 410-418.
    CrossrefPubMedGoogle Scholar
  • 57 Strahlenschutzverordnung (StrlSchV).. 15. Auflage 2009. Carl Heymanns Verlag;
  • 58 Taillefer R, DePuey EG, Udelson JE. et al. Comparative diagnostic accuracy of 201Tl and 99mTc ses-tamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997; 29: 69-77.
    CrossrefPubMedGoogle Scholar
  • 59 Taylor JC, Froberg SA, Hillel PG. et al. Correlation of left ventricular count rate with patient weight in Tc-99m myocardial perfusion imaging. Nucl Med Commun 2011; 32: 279-283.
    CrossrefPubMedGoogle Scholar
  • 60 Thomas GS, Tammelin BR, Schiffman GL. et al. Safety of regadenoson, a selective adenosine A2A agonist, in patients with chronic obstructive pulmonary disease: A randomized, double-blind, placebo-controlled trial (RegCOPD trial). J Nucl Cardiol 2008; 15: 319-328.
    CrossrefPubMedGoogle Scholar
  • 61 Thomas GS, Thompson RC, Miyamoto MI. et al. The RegEx trial: a randomized, double-blind, placebo- and active-controlled pilot study combining regadenoson, a selective A(2A) adenosine agonist, with low-level exercise, in patients under going myocardial perfusion imaging. J Nucl Cardiol 2009; 16: 63-72.
    CrossrefPubMedGoogle Scholar
  • 62 Vaduganathan P, He ZX, Raghavan C. et al. Detection of left anterior descending coronary artery stenosis in patients with left bundle branch block: exercise, adenosine or dobutamine imaging?. J Am Coll Cardiol 1996; 28: 543-550.
    CrossrefPubMedGoogle Scholar
  • 63 Van Dongen AJ, van Rijk PP. Minimizing liver, bowel, and gastric activity in myocardial perfusion SPECT. J Nucl Med 2000; 41: 1315-1317.
    PubMedGoogle Scholar
  • 64 Van Train KF, Areeda J, Garcia EV. et al. Quantitative same-day rest-stress technetium-99m-sesta-mibi SPECT: definition and validation of stress normal limits and criteria for abnormality. J Nucl Med 1993; 34: 1494-1502.
    PubMedGoogle Scholar
  • 65 Yoon AJ, Melduni RM, Duncan SA. et al. The effect of betablockers on the diagnostic accuracy of vasodilator pharmacologic SPECT myocardial perfusion imaging. J Nucl Cardiol 2009; 16: 358-367.
    CrossrefPubMedGoogle Scholar
  • 66 Zoghbi GJ, Iskandrian AE. Exercise myocardial perfusion imaging. Iskandrian AI, Garcia EV. Nuclear Cardiac Imaging.. New York: Oxford University Press; 2008: 267-292.
    Google Scholar