PET/CT検診による症状がない高齢者心疾患の検出

Importance of using PET/CT to detect coronary or aortic diseases in elderly asymptomatic patients

2017年の死亡者数は，がん疾患で373,334人，心疾患で201,837人で，死亡率は，前年と比較してがん疾患で1.2％増，心疾患で5.9％増であった^1）。平成時代の我が国における心疾患の死亡率・罹患率の動向によると，1990年にいったん減少した心疾患の死亡数が，その後増加傾向にある。人口の高齢化に伴い心疾患全体の粗死亡率が増えているものの，急性心筋梗塞を含む冠動脈疾患の粗死亡率は必ずしも増加していない。しかし，高齢化とともに心房細動の有病率が高くなり，脳塞栓などの心原性塞栓症や心不全のリスクも高くなっている。

The number of patients who require repeat assessments and of older persons who undergo health checks using PET/CT has increased over the past 10 years. More patients need to be screened or monitored for cardiac diseases, degenerative changes in cardiac valve due to progression of arteriosclerotic process as well as cancer. The accumulation of F-18-fluorodeoxyglucose（FDG）in the LAD territory of a 65-year-old patient with diabetes mellitus without chest pain revealed dense calcification in the left coronary artery and 99％ stenosis in the left main trunk. A coronary stent was deployed to prevent myocardial infarction. Echocardiography of an 84-year-old patient with a sequentially dilated left atrium revealed moderate aortic stenosis. Therapy for aortic stenosis can comprise transcatheter aortic valve implantation, in the same manner as coronary intervention. To detect asymptomatic coronary or aortic diseases among elderly individuals using PET/CT at the time of scheduled health checks is very important.