Hybrid Imaging: Calcium Score and Myocardial Perfusion Imaging

IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
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引用次数: 0

Abstract

Coronary heart disease (CHD) remains the top cause of death due to cardiovascular conditions worldwide, with someone suffering a myocardial infarction every 40 seconds. This highlights the importance of non-invasive imaging technologies like myocardial perfusion imaging (MPI), which are crucial for detecting coronary artery disease (CAD) early, even before symptoms appear. However, the reliance solely on MPI has shifted due to its limitations in definitively ruling out atherosclerosis, leading to the adoption of hybrid imaging techniques. Hybrid imaging combines computed tomography (CT) with MPI techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). This integration, often within a single gantry system, enhances the diagnostic accuracy by allowing for attenuation correction (AC), acquisition of the coronary artery calcium score (CACS), and more precise tracing of radiotracer uptake. The built-in CT in modern MPI systems assists in these functions, which is essential for better diagnosis and risk assessment in patients. The addition of CACS to MPI, a method involving the assessment of calcified plaque in coronary arteries, notably enhances diagnostic and prognostic capabilities. CACS helps in identifying atherosclerosis and predicting potential cardiac events, facilitating personalized risk management and the initiation of tailored interventions like statins and aspirin. Such comprehensive imaging strategies not only improve the accuracy of detecting CAD but also help in stratifying patient risk more effectively. In this paper, we discuss how the incorporation of CAC into MPI protocols enhances the diagnostic sensitivity for detecting obstructive CAD, as evidenced by several studies where the addition of CAC to MPI has led to improved outcomes in diagnosing CAD. Moreover, CAC has been shown to unmask silent coronary atherosclerosis in patients with normal MPI results, highlighting its incremental diagnostic value. We will discuss the evolving role of hybrid imaging in guiding therapeutic decisions, particularly the use of statins for cardiovascular prevention. The integration of CAC assessment with MPI not only aids in the early detection and management of CAD but also optimizes therapeutic strategies, enhancing patient care through a more accurate and personalized approach. Such advancements underscore the need for further research to fully establish the benefits of combining CAC with MPI in the clinical assessment of cardiovascular risk.

混合成像:钙化评分和心肌灌注成像。
冠心病(CHD)仍然是全球心血管疾病导致死亡的首要原因,每 40 秒就有一人发生心肌梗塞。这凸显了心肌灌注成像(MPI)等非侵入性成像技术的重要性,这些技术对于在症状出现之前及早发现冠状动脉疾病(CAD)至关重要。然而,由于 MPI 在明确排除动脉粥样硬化方面的局限性,对 MPI 的单纯依赖已经发生了转变,从而导致了混合成像技术的采用。混合成像将计算机断层扫描(CT)与正电子发射断层扫描(PET)和单光子发射计算机断层扫描(SPECT)等 MPI 技术相结合。这种整合通常在一个龙门系统内进行,可通过衰减校正(AC)、获取冠状动脉钙化评分(CACS)和更精确地追踪放射性示踪剂摄取来提高诊断准确性。现代 MPI 系统的内置 CT 可协助实现这些功能,这对于更好地诊断和评估患者的风险至关重要。CACS 是一种评估冠状动脉钙化斑块的方法,在 MPI 中加入 CACS 可显著提高诊断和预后能力。CACS 有助于识别动脉粥样硬化和预测潜在的心脏事件,促进个性化风险管理和启动有针对性的干预措施,如他汀类药物和阿司匹林。这种全面的成像策略不仅能提高检测 CAD 的准确性,还有助于更有效地对患者进行风险分层。在本文中,我们将讨论如何将 CAC 纳入 MPI 方案,以提高检测阻塞性 CAD 的诊断灵敏度,多项研究证明,在 MPI 中加入 CAC 可改善 CAD 的诊断结果。此外,CAC 还能揭示 MPI 结果正常的患者中无声的冠状动脉粥样硬化,突出了其增量诊断价值。我们将讨论混合成像在指导治疗决策,尤其是使用他汀类药物预防心血管疾病方面不断发展的作用。CAC 评估与 MPI 的整合不仅有助于 CAD 的早期检测和管理,还能优化治疗策略,通过更准确和个性化的方法加强对患者的护理。这些进步强调了进一步研究的必要性,以充分确定在心血管风险临床评估中将 CAC 与 MPI 相结合的益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Seminars in nuclear medicine
Seminars in nuclear medicine 医学-核医学
CiteScore
9.80
自引率
6.10%
发文量
86
审稿时长
14 days
期刊介绍: Seminars in Nuclear Medicine is the leading review journal in nuclear medicine. Each issue brings you expert reviews and commentary on a single topic as selected by the Editors. The journal contains extensive coverage of the field of nuclear medicine, including PET, SPECT, and other molecular imaging studies, and related imaging studies. Full-color illustrations are used throughout to highlight important findings. Seminars is included in PubMed/Medline, Thomson/ISI, and other major scientific indexes.
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