Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
Breast Cancer Res Treat. 2017 Jul;164(2):253-262. doi: 10.1007/s10549-017-4248-y. Epub 2017 Apr 21.
Cardiac single-photon emission computed tomography (SPECT) is often used to identify defects in myocardial perfusion due to atherosclerotic coronary artery disease. It was also used in studies to evaluate radiation therapy (RT)-associated cardiac abnormalities. In the current review, we aim to evaluate the rates of post-RT cardiac SPECT early perfusion abnormalities and relate this to the irradiated left ventricular volume.
The studies cited in this systematic review were identified using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
Six studies between 1996 and 2016 fulfilled the inclusion criteria. The reported perfusion defects in these studies were seen in the apical and anterolateral aspects of the left ventricle. Three studies show correlation between the percent of the left ventricle within the RT-field and percent of patients with early perfusion defects on cardiac SPECT. In two studies that used cardiac sparing techniques (such as deep inspiration), that resulted in a low mean heart dose, no perfusion defects were noted.
Data suggest that incidental irradiation of the heart in cases of left breast/chest wall RT can result in early post-RT perfusion defects on cardiac SPECT. There appears to be strong dose/volume dependence to the risk, and hence techniques to reduce cardiac exposure are recommended.
心脏单光子发射计算机断层扫描（SPECT）常用于识别由于动脉粥样硬化性冠状动脉疾病引起的心肌灌注缺陷。它也被用于评估放射治疗（RT）相关的心脏异常的研究中。在本综述中，我们旨在评估 RT 后心脏 SPECT 早期灌注异常的发生率，并将其与受照射的左心室容积相关联。
本系统评价中引用的研究是根据系统评价和荟萃分析的首选报告项目（PRISMA）指南确定的。
1996 年至 2016 年间的 6 项研究符合纳入标准。这些研究报告的灌注缺陷出现在左心室的心尖和前外侧。三项研究表明，RT 区域内左心室的百分比与心脏 SPECT 上早期灌注缺陷患者的百分比之间存在相关性。在两项使用心脏保护技术（如深呼吸）的研究中，这导致平均心脏剂量较低，未观察到灌注缺陷。
数据表明，左侧乳房/胸壁 RT 中心脏的偶然照射可能导致 RT 后心脏 SPECT 早期出现灌注缺陷。似乎存在强烈的剂量/体积依赖性风险，因此建议采用降低心脏暴露的技术。
