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DOI: 10.1055/s-0030-1255673
© Georg Thieme Verlag KG Stuttgart · New York
Hat die Myokardszintigrafie heute noch einen Stellenwert in der Kardiologie?
Publication History
Publication Date:
21 September 2010 (online)
![](https://www.thieme-connect.de/media/kardiologie-u2d/201003/lookinside/thumbnails/10.1055-s-0030-1255673-1.jpg)
Abstract
Myocardial perfusion scintigraphy evolved into the modality of choice regarding non-invasive imaging for the presence of obstructive coronary artery disease (CAD) in patients with clinically suspected or already known CAD in the 80ies and 90ies. However, new non-invasive imaging modalities such as cardiovascular magnetic resonance imaging (CMR) have been established in the last years and are challenging the clinical predominance of myocardial perfusion scintigraphy in evaluating myocardial ischemia and thereby constituting the gatekeeper to invasive cardiac catheterization. In particular, CMR-based methods (comprising dobutamine-stress-CMR and adenosine-perfusion-CMR) offer at least equal diagnostic accuracy compared to conventional myocardial perfusion scintigraphy while having less side effects (e. g. no radiation burden). Therefore, the present and future clinical value of myocardial perfusion scintigraphy may become seriously questioned. In this review, the present clinical value of myocardial perfusion scintigraphy is critically assessed in comparison to CMR-based imaging modalities.
Literatur
- 1 Hendel R C, Verani M S, Miller D D. et al . Diagnostic utility of tomographic myocardial perfusion imaging with technetium 99 m furifosmin (Q12) compared with thallium 201: results of a phase III multicenter trial. J Nucl Cardiol. 1996; 3 291-300
- 2 Hor G. Myocardial scintigraphy – 25 years after start. Eur J Nucl Med. 1988; 13 619-636
- 3 Fox K, Garcia M A, Ardissino D. et al . Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J. 2006; 27 1341-1381
- 4 Gibbons R J, Chatterjee K, Daley J. et al . ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 1999; 33 2092-2197
- 5 Schinkel A F, Bax J J, Geleijnse M L. et al . Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?. Eur Heart J. 2003; 24 789-800
- 6 Garber A M, Solomon N A. Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med. 1999; 130 719-28
- 7 Shaw L J, Iskandrian A E. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004; 11 171-185
- 8 Abdel F A, Kamal A M, Pancholy S. et al . Prognostic implications of normal exercise tomographic thallium images in patients with angiographic evidence of significant coronary artery disease. Am J Cardiol. 1994; 74 769-771
- 9 Schalet B D, Kegel J G, Heo J. et al . Prognostic implications of normal exercise SPECT thallium images in patients with strongly positive exercise electrocardiograms. Am J Cardiol. 1993; 72 1201-1203
- 10 Hachamovitch R, Hayes S W, Friedman J D. 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
- 11 Nationale Versorgungsleitlinien chronische KHK. Version 1.6 http://www.versorgungsleitlinien.de ; Stand: 10 / 2007
- 12 Lindner O, Burchert W, Bengel F M. et al . Myocardial perfusion scintigraphy in Germany. Results of the 2005 query and current status. Nuklearmedizin. 2007; 46 49-55
- 13 Lindner O, Burchert W, Bengel F M. et al . Myocardial perfusion scintigraphy 2008 in Germany – results of the fourth query. Nuklearmedizin. 2010; 49 65-72
- 14 Hundley W G, Bluemke D A, Finn J P. et al . ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010; 55 2614-2662
- 15 Yilmaz A, Sechtem U. Cardiac imaging in suspected coronary artery disease. Dtsch Med Wochenschr. 2008; 133 644-649
- 16 Nandalur K R, Dwamena B A, Choudhri A F. et al . Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2007; 50 1343-1353
- 17 Schwitter J, Wacker C M, van Rossum A C. et al . MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 2008; 29 480-489
- 18 Jahnke C, Nagel E, Gebker R. et al . Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation. 2007; 115 1769-1776
- 19 Yilmaz A, Sechtem U. Risk prediction using cardiovascular magnetic resonance imaging. Dtsch Med Wochenschr. 2009; 134 2008-2012
- 20 Kim R J, Wu E, Rafael A. et al . The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000; 343 1445-1453
- 21 Hendel R C, Patel M R, Kramer C M. et al . ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. J Am Coll Cardiol. 2006; 48 1475-1497
- 22 Bundesamt für Strahlenschutz: Strahlenthemen: Röntgendiagnostik. 2007. http://www.bfs.de/de/bfs/druck/strahlenthemen/STTH_Roentgen.pdf ; Stand: 07/2010
- 23 Wackers F J. Artifacts in planar and SPECT myocardial perfusion imaging. Am J Card Imaging. 1992; 6 42-57
- 24 Mahrholdt H, Zhydkov A, Hager S. et al . Left ventricular wall motion abnormalities as well as reduced wall thickness can cause false positive results of routine SPECT perfusion imaging for detection of myocardial infarction. Eur Heart J. 2005; 26 2127-2135
- 25 Baccouche H, Mahrholdt H, Meinhardt G. et al . Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease. Eur Heart J. 2009; 30 2869-2879
- 26 Aletras A H, Kellman P, Derbyshire J A, Arai A E. ACUT2E TSE-SSFP: a hybrid method for T2-weighted imaging of edema in the heart. Magn Reson Med. 2008; 59 229-235
- 27 Nahrendorf M, Jaffer F A, Kelly K A. et al . Noninvasive vascular cell adhesion molecule-1 imaging identifies inflammatory activation of cells in atherosclerosis. Circulation. 2006; 114 1504-1511
- 28 Boden W E, O'Rourke R A, Teo K K. et al . Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356 1503-1516
- 29 Shaw L J, Berman D S, Maron D J. et al . Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008; 117 1283-1291
- 30 Hofstra L, Liem I H, Dumont E A. et al . Visualisation of cell death in vivo in patients with acute myocardial infarction. Lancet. 2000; 356 209-212
Prof. Dr. med. Udo Sechtem
Abteilung für Kardiologie
Robert-Bosch-Krankenhaus
Auerbachstraße 110
70376 Stuttgart
Email: udo.sechtem@rbk.de