Diekmann Johanna, Bengel Frank M
Dtsch Med Wochenschr. 2022 Apr;147(9):538-548. doi: 10.1055/a-1554-8415. Epub 2022 Apr 25.
Cardiac nuclear medicine comprises various diagnostic techniques using radiopharmaceuticals for functional imaging in vivo. This article provides an overview of current clinical use of cardiac imaging in nuclear medicine in Germany: Myocardial perfusion imaging using SPECT is a well-established noninvasive tool to semi-quantitatively measure left ventricular myocardial perfusion. Ischemia and chronic myocardial scars can be idenified with a high diagnostic accuracy. Gated SPECT enables measuring left ventricular function. With new dedicated solid-state camera systems examinations have become faster and better while radiation exposure has been minimized. These new camera systems allow quantitative calculations of myocardial blood flow, which will further improve diagnostic accuracy.For patients with severe chronic coronary artery disease and myocardial dysfunction analyzing myocardial viability is crucial for guiding therpeutic decisions. For detection of hibernating myocardium and its differentiation from scar tissue, two nuclear cardiac methods are combined: Rest myocardial perfusion imaging detects perfusion defects and cardiac 18F-FDG-PET/CT detects glucose metabolism in the hypoperfused area. As long as glucose metabolism is intact therapeutic interventions can be beneficial.In general 18F-FDG-PET/CT allows visualization and quantification of celluar glucose metabolism in oncologic and inflammatory processes. For analysis of cardiac inflammation (e. g. endocarditis or sarcoidosis) a no-carb and high-protein diet is needed at leat 24 hours prior to imaging in order to suppress the physiologic myocardial glucose metabolism. Then, specific inflammatory tracer uptake can be assessed.Cardiac amyloidosis is a rare but dangerous condition. With a specific amyloidosis scintigraphy (bone scintigraphy), cardiac ATTR-amyloidosis can be diagnosed with high accuracy. A potenitally harmful myocardial biopsy often is not needed any more and specific therapy can be initiated.In summary, diagnostic methods in cardiac nuclear medicine non-invasively allow visualization and function analysis of biological processes and are essential for diagnosis finding and therapy guidance. The continuous advancement of diagnostic tools makes nuclear cardiology a highly relevant and interesting field.
心脏核医学包括各种利用放射性药物进行体内功能成像的诊断技术。本文概述了德国核医学中心脏成像的当前临床应用：使用单光子发射计算机断层扫描（SPECT）的心肌灌注成像是一种成熟的非侵入性工具，用于半定量测量左心室心肌灌注。缺血和慢性心肌瘢痕能够以较高的诊断准确性被识别出来。门控SPECT能够测量左心室功能。借助新型专用固态相机系统，检查变得更快、更好，同时辐射暴露已降至最低。这些新的相机系统允许对心肌血流进行定量计算，这将进一步提高诊断准确性。对于患有严重慢性冠状动脉疾病和心肌功能障碍的患者，分析心肌存活性对于指导治疗决策至关重要。为了检测冬眠心肌并将其与瘢痕组织区分开来，两种心脏核医学方法被结合使用：静息心肌灌注成像检测灌注缺损，心脏18F-氟脱氧葡萄糖正电子发射断层显像/计算机断层扫描（18F-FDG-PET/CT）检测灌注不足区域的葡萄糖代谢。只要葡萄糖代谢完好无损，治疗干预可能会有益处。一般来说，18F-FDG-PET/CT能够在肿瘤学和炎症过程中可视化并定量细胞葡萄糖代谢。为了分析心脏炎症（如心内膜炎或结节病），在成像前至少24小时需要无碳水化合物和高蛋白饮食，以抑制生理性心肌葡萄糖代谢。然后，可以评估特定炎症示踪剂的摄取情况。心脏淀粉样变性是一种罕见但危险的病症。通过特定的淀粉样变性闪烁显像（骨闪烁显像），心脏转甲状腺素蛋白淀粉样变性（ATTR-淀粉样变性）能够被高精度诊断出来。通常不再需要进行有潜在危害的心肌活检，并且可以启动特定治疗。总之，心脏核医学中的诊断方法能够非侵入性地可视化并分析生物过程的功能，对于诊断和治疗指导至关重要。诊断工具的不断进步使核心脏病学成为一个高度相关且有趣的领域。
