Cho Sang-Geon, Kim Jahae, Song Ho-Chun
Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea.
Nucl Med Mol Imaging. 2019 Oct;53(5):301-312. doi: 10.1007/s13139-019-00607-9. Epub 2019 Aug 28.
Recent clinical trials have demonstrated the values of cardiac computed tomography (CT) in the initial evaluation of stable chest pain which led to drastic changes in the National Institute for Health and Care Excellence (NICE) guidelines in 2016. According to the updated NICE guidelines, cardiac CT should be performed as the initial cardiac testing in stable chest pain regardless of pre-test probability (PTP) of coronary artery disease (CAD). As a result, cardiac CT is now considered as a validated gatekeeper for assessing stable chest pain, which precedes all the functional studies including nuclear myocardial perfusion imaging (MPI). Nuclear MPI, in contrast, has been assigned as one of the second-line studies, which is inevitably dependent on the results of cardiac CT. However, nuclear MPI has genuine values in the diagnosis, treatment decision, and prognostic stratification of stable chest pain, which cannot be replaced by cardiac CT. In this review, the updated NICE guidelines and related cardiac CT trials will be critically reviewed from the view of nuclear physicians and the exceptional values of nuclear MPI will be described along with the future perspectives.
近期的临床试验已证明心脏计算机断层扫描（CT）在稳定型胸痛初始评估中的价值，这导致2016年英国国家卫生与临床优化研究所（NICE）指南发生了重大变化。根据更新后的NICE指南，无论冠状动脉疾病（CAD）的检测前概率（PTP）如何，心脏CT都应作为稳定型胸痛的初始心脏检查。因此，心脏CT现在被视为评估稳定型胸痛的有效把关手段，在包括核心肌灌注成像（MPI）在内的所有功能研究之前进行。相比之下，核MPI已被列为二线检查之一，不可避免地依赖于心脏CT的结果。然而，核MPI在稳定型胸痛的诊断、治疗决策和预后分层方面具有不可被心脏CT替代的真正价值。在本综述中，将从核医学医生的角度对更新后的NICE指南和相关心脏CT试验进行批判性回顾，并描述核MPI的特殊价值以及未来展望。
