Kardiale Hybridbildgebung

Article

Zusammenfassung

CT-Koronarangiographie und Myokardperfusionsszintigraphie (MP-SPECT) sind etablierte nichtinvasive Untersuchungsmodalitäten in der Diagnostik der koronaren Herzerkrankung (KHK). Die kardiale Hybridbildgebung kombiniert beide Modalitäten zu einem Fusionsbild und ermöglicht damit die Integration morphologischer (Koronaranatomie, Stenosen) und funktioneller (Myokardperfusion) Aspekte der KHK. Die klinische Einführung der kardialen Hybridbildgebung, unterstützt durch die vermehrte Verfügbarkeit von Hybridgeräten, hat aber auch eine Kontroverse über die entsprechenden Indikationen dieser Untersuchung aufgeworfen. Erste Fallserien von spezialisierten Zentren haben die Durchführbarkeit von kardialen Hybriduntersuchungen sowie einen klinischen Nutzen bei bestimmten Patientengruppen dokumentiert. Durch die räumliche Zuordnung von Perfusionsdefekten zu den dazugehörigen Stenosen erlaubt es die Hybridbildgebung, die hämodynamische Relevanz von Koronarläsionen akkurat zu ermitteln und damit die Entscheidung zu einer allfälligen Revaskularisation entscheidend zu beeinflussen. Dank den Fortschritten bezüglich Strahlenreduktion und dem zunehmenden klinischen Interesse, ist damit zu rechnen, dass die kardiale Hybridbildgebung immer mehr in den klinischen Alltag Einzug halten wird.

Schlüsselwörter

Kardiale Hybridbildgebung Myokardperfusions-Szintigraphie Positronenemissions-Tomographie Koronare Herzkrankheit 

Cardiac hybrid imaging

Abstract

CT coronary angiography and myocardial perfusion scintigraphy are both established noninvasive techniques for the diagnosis of coronary artery disease (CAD). Cardiac hybrid imaging consists of the combination (or fusion) of both modalities and allows obtaining complementary morphological (coronary anatomy, stenoses) and functional (myocardial perfusion) information in a single image. The increased availability of these techniques in clinical practice has also raised a controversy with regard to which patients should undergo such integrated examinations. The feasibility and clinical value of hybrid imaging has been documented in small cohort studies and selected series of patients. The incremental value of the hybrid technique arises from the spatial co-registration of perfusion defects with coronary stenoses. This allows an assessment of the hemodynamic relevance of coronary stenoses and the determination of the need for revascularization procedures in each individual artery. Thus, it can be anticipated that the ongoing efforts to reduce radiation exposure and the increasing clinical interest will further pave the way for an ever-increasing use of cardiac hybrid imaging in clinical practice.

Keywords

Cardiac hybrid imaging Single photon emission computed tomography Positron emission tomography Coronary artery disease 

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© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Kardiovaskuläres Zentrum, Abteilung HerzbildgebungUniversitätsspital ZürichZürichSchweiz

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