Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
JACC Cardiovasc Imaging. 2014 Jan;7(1):79-96. doi: 10.1016/j.jcmg.2013.05.022.
Myocardial perfusion imaging (MPI) with gated single-photon emission tomography provides important information on the extent and severity of myocardial perfusion abnormalities, including myocardial ischemia. The availability of software for automated quantitative assessment of myocardial perfusion in an objective and more reproducible manner than visual assessment has allowed MPI to be particularly effective in serial evaluation. Serial testing using MPI is widely used in guiding patient care despite the lack of well-defined appropriateness use criteria. This should not be surprising because ischemic heart disease is a life-long malady subject to dynamic changes throughout its natural course and particularly following man-made interventions that may improve or worsen the disease process, such as medical therapy and coronary revascularization. Serial MPI has filled an important clinical gap by providing crucial information for managing patients with changes in clinical presentations or in anticipation of such changes in patients with stable symptoms. In the research arena, serial MPI has been widely applied in randomized controlled trials to study the impact of various medical and interventional therapies on myocardial perfusion, as well as the relative merits of new imaging procedures (hardware and/or software), radiotracers, and stressor agents. Serial testing, however, unlike initial or 1-time testing, has more stringent requirements and is subject to variability because of technical, procedural, interpretational, and biological factors. The intrinsic variability of MPI becomes important in interpreting serial tests in order to define a true change in a given patient and to guide clinical decision making. The purpose of this first comprehensive review on this subject is to illustrate where serial MPI may be useful clinically and in research studies, and to highlight strategies for addressing the various issues that are unique to serial testing in order to derive more valid and robust data from the serial scans.
门控单光子发射断层扫描心肌灌注成像（MPI）提供了有关心肌灌注异常（包括心肌缺血）的范围和严重程度的重要信息。软件的可用性允许以比视觉评估更客观和更可重复的方式自动定量评估心肌灌注，这使得 MPI 在连续评估中特别有效。尽管缺乏明确的适宜性使用标准，但使用 MPI 进行连续检测已广泛用于指导患者护理，这并不奇怪，因为缺血性心脏病是一种终身疾病，在其自然病程中会发生动态变化，尤其是在人为干预之后，这些干预可能会改善或恶化疾病进程，例如药物治疗和冠状动脉血运重建。连续 MPI 通过为管理临床症状变化的患者或为有稳定症状的患者预期这些变化提供关键信息，填补了重要的临床空白。在研究领域，连续 MPI 已广泛应用于随机对照试验中，以研究各种药物和介入治疗对心肌灌注的影响，以及新的成像程序（硬件和/或软件）、放射性示踪剂和应激剂的相对优势。然而，与初始或一次性检测不同，连续检测有更严格的要求，并受到技术、程序、解释和生物学因素的变异性的影响。MPI 的固有变异性在解释连续测试中变得重要，以便为给定患者定义真正的变化，并指导临床决策。本主题的第一篇综合综述旨在说明连续 MPI 在临床和研究中的可能用途，并强调解决连续测试中独特的各种问题的策略，以便从连续扫描中获得更有效和稳健的数据。
