Petretta Mario, Soricelli Andrea, Storto Giovanni, Cuocolo Alberto
Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy.
J Nucl Cardiol. 2008 May-Jun;15(3):456-65. doi: 10.1016/j.nuclcard.2008.03.008.
The quantitative assessment of coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease (CAD), allowing judgment of its severity, tracking of disease progression, and evaluation of the anti-ischemic efficacy of therapeutic strategies. Invasive techniques, such as intracoronary Doppler ultrasound and the pressure-derived method, which directly assess CFR velocity and fractional flow reserve, have been used for the evaluation of the physiologic significance of coronary lesions. Considerable progress has been made in the improvement of technologies directed toward the noninvasive quantification of myocardial blood flow and CFR. Positron emission tomography has emerged as an accurate technique to quantify CFR. The absolute measurements obtained with this noninvasive approach have been widely validated. Nevertheless, it has not been applied to routine studies because of its high cost and complexity. On the other hand, technetium 99m-labeled tracers have been largely used for the evaluation of myocardial perfusion with single photon emission computed tomography (SPECT) imaging in patients with suspected or known CAD. Recently, attempts to estimate CFR with SPECT tracers have been made to obtain, with noninvasive methods, data for quantitative functional assessment of CAD. This review analyzes the relative merit and limitations of CFR measurements by cardiac SPECT imaging with Tc-99m-labeled tracers and describes the potential clinical applications of this technique.
冠状动脉血流储备（CFR）的定量评估可能有助于冠状动脉疾病（CAD）的功能评估，从而判断其严重程度、追踪疾病进展以及评估治疗策略的抗缺血疗效。侵入性技术，如冠状动脉内多普勒超声和压力衍生法，可直接评估CFR速度和血流储备分数，已被用于评估冠状动脉病变的生理意义。在针对心肌血流和CFR的无创定量技术改进方面已经取得了相当大的进展。正电子发射断层扫描已成为一种准确量化CFR的技术。这种无创方法获得的绝对测量值已得到广泛验证。然而，由于其成本高和复杂性，尚未应用于常规研究。另一方面，锝99m标记的示踪剂已大量用于通过单光子发射计算机断层扫描（SPECT）成像对疑似或已知CAD患者的心肌灌注进行评估。最近，人们尝试用SPECT示踪剂估计CFR，以便通过无创方法获得CAD定量功能评估的数据。本综述分析了用锝99m标记的示踪剂进行心脏SPECT成像测量CFR的相对优点和局限性，并描述了该技术的潜在临床应用。
