浅谈核素显像在心血管疾病影像诊断学中的地位

无创和有创诊断心血管疾病的影像学方法很多,核素显像在无创诊断心血管疾病上可谓独树一帜:与其它影像学方法侧重于从解剖结构诊断心血管疾病不同,核素显像利用心脏功能显像、心肌代谢显像、心肌神经显像、心肌受体显像、乏氧心肌显像、坏死心肌显像、血栓显像、动脉粥样硬化显像、心肌放射免疫显像等,多方面展示心血管疾病的病理生理、生物化学演变,从而对心血管疾病进行诊断与组织定征。这种以生理、病理生理和生化过程为成像基础的影像学诊断方式,代表了影像学发展的一个重要方向。核素显像不仅用于诊断、鉴别诊断心血管疾病,而且,由于其提供了更多的疾病的生理病理和生化特征性变化信息,如冠心病病人梗塞心肌内有无存活心肌(有无糖、脂肪代谢),该节段室壁运动如何,左室整体功能等,能动态检测治疗效果,有效预测病人疗效和预后,从而有利于最佳诊断、治疗方案的选择。本文重点从对心血管疾病的解剖形态学、功能、灌注、代谢和组织定征诊断上阐述了核素显像在心血管疾病影像诊断学中的地位。和其它影像学方法比较,显示疾病的解剖结构变化不是核素显像的长项,但是,核素显像在显示疾病的灌注、代谢上处于领先位置,利用其它影像学方法显示心肌灌注、代谢的研究也正在进行中,有的也显示了良好的临床应用前景

Update of Nuclear Medicine in the Cardiovascular Imaging

There are a lot of invasive and nonin-vasive diagnostic methods to detect cardiovascular dis-ease. Radionuclide imaging is the unique methodbasing on the functional and pathophysiologic changesfor diagnosis of cardiovascular disease, while othermethods basing on anatomic and structural changes main-ly. The development of imagings basing on the functionaland pathophysiologic changes is one of the most importattrends in the development of cardiovascular imagings.With cardiac function imaging, myocardial perfusion imag- ing, myocardial metabolic imaging, myocardial recep-tor imaging, necrotic myocardium imaging, thrombiimaging and hypoxic myocardium imaging, radionu-clide imagings show the tissue characteristics of car-diovascular disease. By the physiopathologic andfunctional imaging of nuclear medicine, the diagnosisand prognosis of cardiovascular disease information ofoffered, which is very important to the strategy of di-agnosis and management. In this review, theanatomic imaging, myocardial perfusion imaging andmyocardial metabolic imaging of nuclear medicine andcardiac function assessed and tissue characteristicsdetermined by imagings are the main topics. The a-bility of showing anatomic changes of cardiovascular dis-ease of nuclide imaging is limited by its lower space res-olution. However, the myocardial perfusion andmetabolism detected by nuclide imagings have been devel-oped, and employed widely and conventionally in diagno-sis, prognosis and management of patients, while thosedetected by other imaging techniques are developing,showing nice future. Nuclide imaging is the unique oneto detect myocardial receptor and nervous distribution,which has wide potential used clinically. Overall, exhibit-ing tissue characteristics of cardiovascular disease shouldbe one of the main developing fields of cardiovascularimaging.