Nuklearmedizin 1995; 34(03): 118-126
DOI: 10.1055/s-0038-1629767
Original Article
Schattauer GmbH

Möglichkeiten und Grenzen der Myokardperfusionsszintigraphie für die Yitalitätsdiagnostik

Potential and Limitation of Myocardial Perfusion Scintigraphy for Detection of Viability
W. H. Knapp
1   Aus der Klinik und Poliklinik für Nuklearmedizin, Universität Leipzig, FRG
› Author Affiliations
Further Information

Publication History

Eingegangen: 01 December 1994

Publication Date:
03 February 2018 (online)

Zusammenfassung

Die nuklearmedizinische Diagnostik der Myokardvitalität wird notwendig vor Therapieentscheidungen oder zur Prognoseabschätzung bei Patienten mit segmentaler kontraktiler Dysfunktion im Rahmen einer koronaren Herzkrankheit. Von vier pathophysiologisch unterscheidbaren Formen der kontraktilen Dysfunktion sind hibernierendes Myokard und Narbe mit reinen Perfusionsindikatoren nicht zu differenzieren. Aufgrund der Determinanten für die Aktivitätsverteilung bei Spätaufnahmen nach 201TI-lnjektion kann mit diesem Radiopharmakon in vielen Fällen eine Differenzierung zwischen myokardialer Ruheischämie und Narbe vorgenommen werden. Die Differenzierung zwischen dem myokardialen »Stunning« einerseits und Ruheischämie oder Narbe andererseits bereitet mit den heute zur Verfügung stehenden Perfusionsindikatoren keine Schwierigkeit. Obwohl die 201TI-Szintigraphie mit optimiertem Untersuchungsprotokoll in ihren Ergebnissen der Vitalitätsdiagnostik denen der Positronen-Emissions-Tomographie mit 18F-FDG nahe kommt, bleibt letztere die Referenzmethode, v. a. bei Vorliegen einer hochgradigen linksventrikulären Dysfunktion und bekannten Koronarverschlüssen.

Summary

Scintigraphic detection of myocardial viability is required for treatment planning and prognostication in patients with contractile dysfunction. There are four pathophysiological entities of dysfunction in coronary artery disease; one of them, “hibernating” myocardium, cannot be differentiated from scar or necrosis by mere perfusion imaging. Due to the determinants of delayed activity distribution after 201TI injection, optimized imaging protocols using this tracer allow for adequate differentiation in many instants. Differentiation between “stunned” and “hibernating” myocardium or scar is achieved with all perfusion indicators actually available. Though 201TI imaging with optimized protocols is almost as efficacious in viability detection as 18F-FDG positron emission tomography, the latter actually remains the reference method particularly in patients with severe left ventricular dysfunction at coronary occlusions.

 
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