心筋虚血を核医学で評価することの有用性と発展性

Clinical utility of nuclear imaging for the evaluation of myocardial ischemia

日本において，冠動脈カテーテルインターベンション（経皮的冠動脈形成術）による冠血行再建術が広まるにつれ，術前の虚血評価の必要性および有用性がこれまで以上に強調されるようになってきた。近年膨大となる医療費の抑制方針に基づくものであるが，本来は血行再建術前に虚血評価を行うことは必須のことである。

There is a lot of evidence for the usefulness of ischemia evaluation on nuclear imaging, and ischemia evaluation reportedly has a high diagnostic accuracy for coronary stenosis. Transient ischemic dilatation and right ventricular accumulation during stress are signs of severe multi-vessel disease. Stress myocardial perfusion single-photon emission computed tomography is recommended for patients at moderate to high risk of ischemic heart disease, and is also useful for prognostic evaluation. Furthermore, myocardial metabolic imaging using 123I-BMIPP is useful in identifying the culprit lesion responsible for acute myocardial ischemia in patients with multi-vessel disease, and in evaluating the presence of ischemic heart disease in patients with heart failure. Coronary intervention should be performed to improve the prognosis and quality of life. Dynamic perfusion study with a semiconductor detector enables the evaluation of early blood flow dynamics, which may lead to higher sensitivity and accuracy of ischemia evaluation in the future.