La scintigrafia miocardica

  • Maria Lucia Calcagni
  • Isabella Bruno
  • Lucia Leccisotti

Abstract

La scintigrafia miocardica (SPET o PET) è una tecnica medico-nucleare non invasiva di imaging che, grazie all’impiego di opportuni radiofarmaci e alla sincronizzazione con l’elettrocardiogramma (ECG-gated), consente di valutare laperfusione miocardica in condizioni di riposo e dopo sforzo (fisico o farmacologico), la vitalità miocardica, la funzione ventricolare sinistra e l’innervazione adrenergica cardiaca. Nella pratica clinica la scintigrafia miocardica da sforzo è indicata negli atleti di età inferiore a 30 anni con alterazioni elettrocardiografiche o ecocardiografiche e negli atleti “master” che presentano la stessa probabilità di cardiopatia ischemica della popolazione normale. É stato dimostrato che un test da sforzo positivo con scintigrafia miocardica negativa ha un alto valore predittivo negativo in questi soggetti. Gli studi di innervazione adrenergica cardiaca e gli studi di perfusione PET sono generalmente impiegati in casi particolari come la displasia aritmogena del ventricolo destro e la miocardiopatia ipertrofica dell’atleta.

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Bibliografia

  1. 1.
    Tamaki N, Morita K (2005) SPET in cardiology. Diagnosis, prognosis, and management of patients with coronary artery disease. Q J Nucl Med Mol Imaging 49:193–203PubMedGoogle Scholar
  2. 2.
    Cerqueira MD (2006) Nuclear cardiology: finally a one-stop shop for diagnosis, risk stratification and management of coronary artery disease. Clin Cardiol 29:126–133CrossRefGoogle Scholar
  3. 3.
    Brindis RG, Douglas PS, Hendel RC et al (2005) ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol 46:1587–1605PubMedCrossRefGoogle Scholar
  4. 4.
    Underwood SR, Anagnostopoulos C, Cerqueira M et al (2004) Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging 31:261–291PubMedCrossRefGoogle Scholar
  5. 5.
    Marcassa C, Bax JJ, Bengel F et al (2008) Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement. Eur Heart J 29:557–563PubMedCrossRefGoogle Scholar
  6. 6.
    Serra-Grima R, Estorch M, Carriò I et al (2000) Marked ventricular repolarization abnormalities in highly trained athletes’ electrocardiograms: clinical and prognostic implications. J Am Coll Cardiol 36:1310PubMedCrossRefGoogle Scholar
  7. 7.
    Bertram P, Toft J, Hanel B et al (1998) False-positive defects in technetium-99m-sestamibi myocardial single-photon emission tomography in healthy athletes with left ventricular hypertrophy. Eur J Nucl Med 25:1308CrossRefGoogle Scholar
  8. 8.
    McCaffrey F, Braden D, Strong W (1991) Sudden cardiac death in young athletes. Am J Dis Child 145:177–183PubMedGoogle Scholar
  9. 9.
    Katzel LI, Fleg JL, Busby-Whitehead MJ et al (1998) Exercise-induced silent myocardial ischaemia in master athletes. Am J Cardiol 81:261PubMedCrossRefGoogle Scholar
  10. 10.
    Hansen CL, Goldstein RA, Akinboboye OO et al (2007) Myocardial perfusion and function: single photon emission computed tomography. J Nucl Cardiol 14:39–60CrossRefGoogle Scholar
  11. 11.
    Mittra E, Quon A (2009) Positron emission tomography/computed tomography: the current technology and applications. Radiol Clin North Am 47:147–160PubMedCrossRefGoogle Scholar
  12. 12.
    Hesse B, Tägil K, Cuocolo A et al (2005) EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 32:855–897PubMedCrossRefGoogle Scholar
  13. 13.
    Estorch M, Serra-Grima R, Carriò I et al (1997) Influence of prolonged exercise on myocardial distribution of 123I’MIBG in long-distance runners. J Nucl Cardiol 4:396–402PubMedCrossRefGoogle Scholar
  14. 14.
    Sisson JC (1993) The adrenergic nervous system of the heart and Nuclear Medicine. In: Freeman LM (ed) Nuclear medicine annual 1993, p 233. Raven Press, New YorkGoogle Scholar
  15. 15.
    Di Carli MF, Dorbala S, Meserve J et al (2007) Clinical myocardial perfusion PET/CT. J Nucl Med 48:783–793PubMedCrossRefGoogle Scholar
  16. 16.
    Schindler TH, Schelbert HR, Quercioli A et al (2010) Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging 3:623–640PubMedCrossRefGoogle Scholar
  17. 17.
    Kjaer A, Meyer C, Wachtell K et al (2005) Positron emission tomographic evaluation of regulation of myocardial perfusion in physiological (elite athletes) and pathological (systemic hypertension) left ventricular hypertrophy. Am J Cardiol 96:1692PubMedCrossRefGoogle Scholar
  18. 18.
    Camici PG, Prasad SK, Rimoldi OE (2008) Stunning, hibernation, and assessment of myocardial viability. Circulation 117:103–114PubMedCrossRefGoogle Scholar
  19. 19.
    Takala TO, Nuutila P, Knuuti J et al (1999) Insulin action on heart and skeletal muscle glucose uptake in weight lifters and endurance athletes. Am J Physiol Endo 276: E706–E711Google Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Maria Lucia Calcagni
    • 1
  • Isabella Bruno
  • Lucia Leccisotti
  1. 1.Istituto di Medicina NucleareUniversità Cattolica del Sacro CuoreRomaItaly

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