Kaufmann Philipp A, Di Carli Marcelo F
Cardiac Imaging Section, University Hospital Zurich, CH-8091 Zurich, Switzerland.
Semin Nucl Med. 2009 Sep;39(5):341-7. doi: 10.1053/j.semnuclmed.2009.03.007.
The past few years have witnessed impressive advances in the field of noninvasive cardiac imaging. For example, computed tomography (CT) coronary angiography has been adopted into daily clinical routine and, at least in some patient populations, is challenging the role of invasive angiography as the anatomic standard of reference. This is because the latter is associated with a nonnegligible periprocedural morbidity and mortality, which suggests confining its use to patients who will benefit from a revascularization procedure. Many factors that are beyond the quantification of anatomic narrowing and therefore cannot be fully appreciated with morphologic assessment will eventually determine whether or not a given lesion produces stress-induced ischemia. Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) is among the most widely used and well-established noninvasive tools for the diagnosis of ischemic coronary disease. It allows assessment of the physiological relevance of coronary lesions and offers a high prognostic predictive value. Although positron emission tomography (PET) may achieve a higher accuracy than SPECT, its use has so far often been limited to large centers. Recent advances in image processing software and the advent of hybrid scanners have paved the way for fusion of image datasets from different modalities. An ideal, noninvasive technique for the diagnosis of coronary artery disease should provide complementary information on coronary anatomy as well as on pathophysiologic lesion severity. SPECT/CT and PET/CT hybrid imaging can provide such unique information, which not only improves diagnostic assessment and risk stratification but may also guide decision making with regard to revascularization in patients with coronary artery disease.
在过去几年中，无创心脏成像领域取得了令人瞩目的进展。例如，计算机断层扫描（CT）冠状动脉造影已被纳入日常临床实践，并且至少在某些患者群体中，正挑战着有创血管造影作为解剖学参考标准的地位。这是因为后者与不可忽视的围手术期发病率和死亡率相关，这表明应将其使用局限于能从血运重建手术中获益的患者。许多超出解剖学狭窄量化范围、因而无法通过形态学评估充分认识的因素，最终将决定某一特定病变是否会引发应激性心肌缺血。单光子发射计算机断层扫描（SPECT）心肌灌注成像，是诊断缺血性冠状动脉疾病最广泛使用且成熟的无创工具之一。它能够评估冠状动脉病变的生理相关性，并具有较高的预后预测价值。尽管正电子发射断层扫描（PET）可能比SPECT具有更高的准确性，但迄今为止其应用往往局限于大型中心。图像处理软件的最新进展以及混合型扫描仪的出现，为融合来自不同模式的图像数据集铺平了道路。一种理想的诊断冠状动脉疾病的无创技术，应能提供有关冠状动脉解剖结构以及病理生理病变严重程度的补充信息。SPECT/CT和PET/CT混合成像能够提供此类独特信息，这不仅能改善诊断评估和风险分层，还可能指导冠状动脉疾病患者血运重建的决策制定。
