Maffeis Caterina, Dondi Francesco, Ribichini Flavio Luciano, Giubbini Raffaele, Gimelli Alessia
Cardiology Division, Department of Medicine, University of Verona, 37126 Verona, Italy.
Nuclear Medicine, ASST Spedali Civili Brescia, 25123 Brescia, Italy.
Rev Cardiovasc Med. 2023 Feb 6;24(2):48. doi: 10.31083/j.rcm2402048. eCollection 2023 Feb.
Myocardial perfusion single photon emission computed tomography (SPECT) is widely used in assessing coronary artery disease (CAD) owing to its proven efficacy in extensive clinical experience. Like other functional tests, myocardial SPECT is recommended for the diagnosis of obstructive CAD, risk stratification assessment, and treatment decision making. Besides quantifying left ventricular volume, global and regional function by electrocardiography (ECG)-gated acquisition, myocardial SPECT can identify myocardial ischemia, scars, stunning, and viable hibernating myocardium. It provides comprehensive functional data across the spectrum of CAD and a cost-effective strategy in patients with intermediate pre-test probability of CAD or with a history of ischemic cardiomyopathy. With ongoing advances in cardiovascular prevention and risk factor management many patients referred for testing now have a low-to-intermediate probability of CAD. Besides, CAD has become a chronic condition resulting from novel therapeutic strategies. Against this background, approaches combining anatomical and functional tests in sequence or simultaneously include coronary artery calcium score integrated with perfusion imaging or fusion SPECT/coronary computed tomography angiography (CCTA). In this review we summarize current indications for myocardial perfusion SPECT and integration of SPECT with other imaging techniques to improve diagnostic performance, patient management, and outcome prediction in CAD.
心肌灌注单光子发射计算机断层扫描（SPECT）因其在广泛临床经验中已证实的疗效而被广泛用于评估冠状动脉疾病（CAD）。与其他功能测试一样，心肌SPECT推荐用于阻塞性CAD的诊断、风险分层评估及治疗决策。除了通过心电图（ECG）门控采集来量化左心室容积、整体和局部功能外，心肌SPECT还能识别心肌缺血、瘢痕、心肌顿抑及存活的冬眠心肌。它能提供涵盖CAD全谱的综合功能数据，且对于CAD预测试概率中等或有缺血性心肌病病史的患者是一种具有成本效益的策略。随着心血管预防和危险因素管理的不断进步，现在许多接受检查的患者CAD概率处于低到中等水平。此外，由于新的治疗策略，CAD已成为一种慢性病。在此背景下，将解剖学和功能测试按顺序或同时结合的方法包括将冠状动脉钙化评分与灌注成像相结合或采用融合SPECT/冠状动脉计算机断层血管造影（CCTA）。在本综述中，我们总结了心肌灌注SPECT的当前适应证以及SPECT与其他成像技术的整合，以提高CAD的诊断性能、患者管理及结局预测。
