Lindner O, Bengel F M, Hacker M, Schäfer W, Burchert W
Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany,
Eur J Nucl Med Mol Imaging. 2014 May;41(5):963-71. doi: 10.1007/s00259-013-2683-5. Epub 2014 Feb 12.
For several years the Working Group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine has been performing a regular survey to obtain information on technique, utilization and development of myocardial perfusion scintigraphy (MPS). Currently, data of six surveys from 2005 to 2012 are available. The aim of this paper is to deliver a general and comprehensive overview of all surveys documenting the course of patient doses over time and the development of the method.
A one-page questionnaire with number of MPS patients, number of stress and rest MPS, referral structure and several technical issues was sent to all centres performing MPS in Germany and evaluated. With the data on protocol utilization, effective MPS patient doses were estimated.
MPS per million population (pmp) varied between 2,380 and 2,770. In 2012, MPS pmp showed a slight increase for the first time. From 2005 to 2009 the angiography to MPS ratio increased from 3.4 to 4.4, and the revascularization to MPS ratio decreased from 0.66 to 0.53. In 2012, both indices demonstrated an opposite trend for the first time (4.1 and 0.55). A total of 108 centres participated in all surveys. They showed an increase in MPS patients of 4.0 % over the reporting period. In 2012, more than 50 % of the centres experienced no change or an increase in MPS numbers. The leading single competitor was MRI, followed by angiography and stress echocardiography. (201)Tl studies have decreased since 2005 from 20 to 5 %. (99m)Tc MPS studies showed a mild increase in 2-day protocols. In 2012, the average effective dose per patient was estimated at 7.4 mSv. Due to the decreasing use of (201)Tl, a mild decline over the observation period can be documented. Dynamic exercise stress was the most common stress test and adenosine the leading pharmacological stress agent, with a growing percentage. In 2012, the regadenoson percentage was 9 %. Gated single photon emission computed tomography (SPECT) noted an increasing acceptance with >70 % in 2012. The segmental scoring of perfusion studies had a low acceptance. Ambulatory care cardiologists represented the major referral group.
Germany has a moderate to moderate-high MPS utilization rate. Nevertheless, coronary artery disease (CAD) diagnosis and disease management are dominated by angiography. The survey data reveal a positive trend in MPS and a decrease in average patient dose reflecting good practice with guideline adherence, the implementation of technical improvements and success in training.
多年来，德国核医学协会心血管核医学工作组一直在定期开展调查，以获取有关心肌灌注显像（MPS）技术、应用情况及发展的信息。目前，已有2005年至2012年六次调查的数据。本文旨在全面综合概述所有调查，记录患者剂量随时间的变化过程以及该方法的发展情况。
向德国所有开展MPS的中心发送了一份单页问卷，内容包括MPS患者数量、负荷和静息MPS数量、转诊结构以及若干技术问题，并进行了评估。利用协议使用数据估算了MPS患者的有效剂量。
每百万人口的MPS（MPS pmp）在2380至2770之间变化。2012年，MPS pmp首次出现轻微增长。2005年至2009年，血管造影与MPS的比例从3.4增至4.4，血运重建与MPS的比例从0.66降至0.53。2012年，这两个指标首次呈现相反趋势（分别为4.1和0.55）。共有108个中心参与了所有调查。在报告期内，这些中心的MPS患者数量增加了4.0%。2012年，超过50%的中心MPS数量未变或有所增加。主要的单一竞争对手是MRI，其次是血管造影和负荷超声心动图。自2005年以来，（201）Tl研究从20%降至5%。（99m）Tc MPS研究在两日方案中略有增加。2012年，每位患者的平均有效剂量估计为7.4 mSv。由于（201）Tl的使用减少，在观察期内可记录到略有下降。动态运动负荷试验是最常见的负荷试验，腺苷是主要的药物负荷剂，且比例不断增加。2012年，瑞加腺苷的比例为9%。门控单光子发射计算机断层扫描（SPECT）的接受度不断提高，2012年超过70%。灌注研究的节段评分接受度较低。门诊心脏病专家是主要的转诊群体。
德国的MPS利用率处于中等至中高水平。尽管如此，冠状动脉疾病（CAD）的诊断和疾病管理仍以血管造影为主。调查数据显示MPS呈积极趋势，平均患者剂量下降，这反映了遵循指南的良好实践、技术改进的实施以及培训的成功。
