核心脏病学目前的作用和未来展望

Nuclear Cardiology: the Present Functions and Future Perspectives

近十年来,负荷单光子发射计算机断层成像心肌灌注显像(SPECT MPI)已成为可疑或已知冠心病(CAD)患者诊断和处理最常用的负荷显像技术,并已得到众多相关临床指南的充分肯定,推荐将SPECT MPI作为冠状动脉造影(CAG)的"守门人",减少不必要的造影。然而,我国的核心脏病学起步较晚,导致部分临床医师对核心脏病学的认识不足。在选择冠状动脉造影、CT冠状动脉造影(CTCA)等技术诊断和处理CAD时,常常存在"误区",以致出现过度应用的趋势。本文将重点介绍核心脏病学目前的作用,简要介绍最近核心脏病学在心脏混合显像及分子显像方面的进展,以促进核心脏病学在我国的合理应用。

For the past decade, the diagnosis and treatment of coronary artery disease （CAD） has shifted from the traditional model by evaluating coronary artery stenosis with morphological imaging methods to a novel model by fo- cusing on the detection of ischemia for risk stratification. The myocardial perfusion imaging （MPI） using stress sin- gle photon emission computed tomography （SPECT） has become the most commonly used stress imaging technique for the diagnosis and treatment of patients with suspected or known CAD. It has got strong supports, including those of the American College of Cardiology, American Heart Association, American Society of Nuclear Cardiology （ACC/AHA/ASNC） and other numerous clinical guidelines. They all stressed that the SPECT MPI is recommended to he used as the ＂gate keeper＂ to coronary angiography in order to prevent unnecessary intervention test and save the cost. However, in China the introduction and application of nuclear cardiology was late and highly unbalanced. This leads to the lack of understanding of nuclear cardiology in some clinicians, and there often is misunderstanding on correct selection of coronary angiography, cardiac CT, CT coronary angiography and others for diagnosis and treat- ment of CAD which results in a trend of over-application of these traditional techniques. In this article, we will focus on the status of nuclear cardiology, including SPECT, positron emission tomography （PET） MPI in the patients with CAD for the diagnosis of ischemia, risk stratification and management decision-making, and also compare it with the traditional morphological imaging techniques. In addition, we will briefly introduce the recent advances in cardiac hybrid imaging and molecular imaging. The aim of this paper is to popularize the knowledge of nuclear cardi- ology, and promote the rational application of nuclear cardiology in China.