Cintilografia de Perfusão Miocárdica: aplicações e avanços recentes

Autores

  • Claudio Tinoco Mesquita Hospital Universitário Antônio Pedro/UFF
  • Davi Shunji Yahiro Hospital Universitário Antônio Pedro/UFF
  • Luciana Morbach Universidade Federal Fluminense (UFF)
  • Mario Arthur Laranja Universidade Federal Fluminense (UFF)
  • Maria Fernanda Mendes Universidade Federal Fluminense (UFF)
  • Mariana Augusta Fischer Universidade Federal Fluminense (UFF)
  • Brenda Ribeiro Universidade Federal Fluminense (UFF)
  • Julia Sales Universidade Federal Fluminense (UFF)
  • Giovane Leal de Azevedo Junior Universidade Federal Fluminense (UFF)
  • Luís Eduardo Machado Hospital Universitário Antônio Pedro/UFF

Palavras-chave:

Cintilografia de Perfusão Miocárdica, Cardiologia Nuclear, Doença Cardiovascular, Imagem Cardiovascular, Medicina Nuclear

Resumo

A cintilografia de perfusão miocárdica é um exame de imagem que fornece informações importantes sobre o fluxo sanguíneo no músculo cardíaco. Este método é amplamente utilizado na investigação diagnóstica para avaliar a perfusão miocárdica e identificar possíveis anormalidades, incluindo a doença arterial coronariana (DAC). O uso de novos radiofármacos e protocolos de imagem específicos permite que a avaliação cardíaca seja mais precisa, melhorando os desfechos clínicos. Por isso, este trabalho tem como objetivo revisar os avanços tecnológicos que auxiliaram a aprimorar essa técnica de imagem como câmaras de CZT e o uso da inteligência artificial. Além disso, com os avanços na área da Medicina Nuclear, surgem também novas discussões sobre os aspectos éticos e de segurança da população.

Biografia do Autor

Claudio Tinoco Mesquita, Hospital Universitário Antônio Pedro/UFF

Serviço de Medicina Nuclear – Hospital Universitário Antônio Pedro/EBSERH/UFF

Hospital Pró-Cardíaco.

Davi Shunji Yahiro, Hospital Universitário Antônio Pedro/UFF

Serviço de Medicina Nuclear – Hospital Universitário Antônio Pedro/EBSERH/UFF

Luciana Morbach, Universidade Federal Fluminense (UFF)

Health, Science & Education Lab – Setor de Radiologia – HUAP/EBSERH/UFF

Mario Arthur Laranja, Universidade Federal Fluminense (UFF)

Health, Science & Education Lab – Setor de Radiologia – HUAP/EBSERH/UFF

Maria Fernanda Mendes, Universidade Federal Fluminense (UFF)

Health, Science & Education Lab – Setor de Radiologia – HUAP/EBSERH/UFF

Mariana Augusta Fischer, Universidade Federal Fluminense (UFF)

Health, Science & Education Lab – Setor de Radiologia – HUAP/EBSERH/UFF

Brenda Ribeiro, Universidade Federal Fluminense (UFF)

Health, Science & Education Lab – Setor de Radiologia – HUAP/EBSERH/UFF

Julia Sales, Universidade Federal Fluminense (UFF)

Health, Science & Education Lab – Setor de Radiologia – HUAP/EBSERH/UFF

Giovane Leal de Azevedo Junior, Universidade Federal Fluminense (UFF)

Health, Science & Education Lab – Setor de Radiologia – HUAP/EBSERH/UFF

Luís Eduardo Machado, Hospital Universitário Antônio Pedro/UFF

Serviço de Medicina Nuclear – Hospital Universitário Antônio Pedro/EBSERH/UFF

Referências

Mensah GA, Fuster V, Murray CJL, Roth GA, Mensah GA, Abate YH, et al. Global Burden of Cardiovascular Diseases and Risks, 1990-2022. J Am Coll Cardiol. 2023 Dec;82(25):2350-473.

Maria Moraes de Oliveira G, Campos Caldeira Brant L, Anne Polanczyk C, Carvalho Malta D, Biolo A, Ramos Nascimento B, et al. Cardiovascular Statistics-Brazil 2023. Arq Bras Cardiol [Internet]. 2023;1-132. Disponível em: www.ibge.gov.br

Mordi IR, Badar AA, John Irving R, Weir-McCall JR, Houston JG, Lang CC. Efficacy of noninvasive cardiac imaging tests in diagnosis and management of stable coronary artery disease. Vol. 13, Vascular Health and Risk Management. Dove Medical Press Ltd.; 2017. p. 427-37.

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019;1-71.

Li DL, Kronenberg MW. Myocardial Perfusion and Viability Imaging in Coronary Artery Disease: Clinical Value in Diagnosis, Prognosis, and Therapeutic Guidance. American Journal of Medicine. 2021 Aug 1;134(8):968-75.

de Azevedo JC, Ferreira Junior DS, Vieira FC, Prezotti LS, Simões LS, Nacif MS, et al. Correlation between myocardial scintigraphy and CT angiography in the evaluation of coronary disease. Arq Bras Cardiol. 2013;100(3).

Arbab-Zadeh A, Miller JM, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, et al. Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomog. J Am Coll Cardiol [Internet]. 2012;59(4):379–87. Disponível em: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3348589&tool=pmcentrez&rendertype=abstract

Reeves RA, Halpern EJ, Rao VM. Cardiac imaging trends from 2010 to 2019 in the medicare population. Radiol Cardiothorac Imaging. 2021 Oct 1;3(5).

Eduardo Mastrocola L, Juarez Amorim B, Vicente Vitola J, Soares Brandão SC, Blacher Grossman G, Souza Leão Lima De R, et al. Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020. Arq Bras Cardiol. 2020 Feb 1;114(2):325-428.

Jimenez-Heffernan A, Butt S, Mesquita CT, Massardo T, Peix A, Kumar A, et al. Technical aspects of gated SPECT MPI assessment of left ventricular dyssynchrony used in the VISION-CRT study. Journal of Nuclear Cardiology. 2021 Jun 1;28(3):1165-71.

Bailly M, Ribeiro MJ, Angoulvant D. Combining flow and reserve measurement during myocardial perfusion imaging: A new era for myocardial perfusion scintigraphy? Vol. 114, Archives of Cardiovascular Diseases. Elsevier Masson s.r.l.; 2021. p. 818-27.

Agostini D, Roule V, Nganoa C, Roth N, Baavour R, Parienti JJ, et al. First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging. 2018;45(7):1079-90.

Gimelli A, Liga R, Giorgetti A, Favilli B, Pasanisi EM, Marzullo P. Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study. Journal of Nuclear Cardiology [Internet]. 2015; Disponível em: http://link.springer.com/10.1007/s12350-015-0247-8

Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease. J Am Coll Cardiol [Internet]. 2017 May;69(17):2212-41. Disponível em: https://linkinghub.elsevier.com/retrieve/pii/S0735109717303856

de Souza-Filho EM, de Amorim Fernandes F. Deep Learning and Artificial Intelligence in Nuclear Cardiology. In: Nuclear Cardiology. Cham: Springer International Publishing; 2021.

Filho EM de S, Fernandes F de A, Soares CL de A, Seixas FL, Dos Santos AASMD, Gismondi RA, et al. Artificial intelligence in cardiology: Concepts, tools and challenges-“the horse is the one who runs, you must be the jockey.” Vol. 114. Arquivos Brasileiros de Cardiologia; 2020. p. 718-25.

Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. Journal of Nuclear Cardiology. 2016 Jun 1;23(3):606-39.

Gimelli A, Pugliese NR, Buechel RR, Coceani M, Clemente A, Kaufmann PA, et al. Myocardial perfusion scintigraphy for risk stratification of patients with coronary artery disease: The AMICO registry. Eur Heart J Cardiovasc Imaging. 2022 Mar 1;23(3):372-80.

Pazhenkottil AP, Ghadri JR, Nkoulou RN, Wolfrum M, Buechel RR, Kuest SM, et al. Improved Outcome Prediction by SPECT Myocardial Perfusion Imaging After CT Attenuation Correction. Journal of Nuclear Medicine [Internet]. 2011;52(2):196-200. Disponível em: http://jnm.snmjournals.org/cgi/doi/10.2967/jnumed.110.080580

Wolak A, Slomka PJ, Fish MB, Lorenzo S, Berman DS, Germano G. Quantitative diagnostic performance of myocardial perfusion SPECT with attenuation correction in women. J Nucl Med [Internet]. 2008 Jun [Citado em: 2014 Jun 20];49(6):915-22. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/18483092

Ou X, Jiang L, Huang R, Li F, Zhao Z, Li L. Computed tomography attenuation correction improves the risk stratification accuracy of myocardial perfusion imaging. Nucl Med Commun [Internet]. 2013;34(5):495-500. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/23478588

Grüning T, Brogsitter C, Khonsari M, Jones IW, Ormsby PL, Burchert W. X-ray-based attenuation correction of myocardial perfusion scans: practical feasibility and diagnostic impact. Nucl Med Commun [Internet]. 2006 Nov;27(11):853-8. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/17021424

Yamauchi Y, Kanzaki Y, Otsuka K, Hayashi M, Okada M, Nogi S, et al. Novel attenuation correction of SPECT images using scatter photopeak window data for the detection of coronary artery disease. J Nucl Cardiol [Internet]. 2014 Feb [Citado em: 2014 May 22];21(1):109–17. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/24185582

Hoefflinghaus T, Husmann L, Valenta I, Moonen C, Gaemperli O, Schepis T, Namdar M, Koepfli P, Siegrist PT, Kaufmann PA. Role of attenuation correction to discriminate defects caused by left bundle branch block versus coronary stenosis in single photon emission computed tomography myocardial perfusion imaging. Clin Nucl Med. 2008 Nov;33(11):748-51. doi: 10.1097/RLU.0b013e318187ee9c. PMID: 18936604.

Takamura T, Horiguchi Y, Kanna M, Matsushita H, Sudo Y, Kikuchi S, et al. Validation of prone myocardial perfusion SPECT with a variable-focus collimator versus supine myocardial perfusion SPECT with or without computed tomography-derived attenuation correction. Ann Nucl Med. 2015;29(10):890-6.

Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Nov 30;78(22):e187-285.

De Bruyne B, Fearon WF, Pijls NHJ, Barbato E, Tonino P, Piroth Z, et al. Fractional Flow Reserve–Guided PCI for Stable Coronary Artery Disease for the FAME 2 Trial Investigators*. N Engl J Med [Internet]. 2014 [Citado em: 2017 Dec 31];371:1208-17. Disponível em: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1408758

Boden W, O’Rourke R, Teo K, Hartigan, Maron D, Kostuk et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. New Engl J Med. 2007;356:1503-16.

Shaw LJ, Blankstein R, Brown DL, Dhruva SS, Douglas PS, Genders TSS, et al. Controversies in Diagnostic Imaging of Patients With Suspected Stable and Acute Chest Pain Syndromes. JACC Cardiovasc Imaging. 2019 Jul 1;12(7):1254-78.

Azadani PN, Miller RJH, Sharir T, Diniz MA, Hu LH, Otaki Y, et al. Impact of Early Revascularization on Major Adverse Cardiovascular Events in Relation to Automatically Quantified Ischemia. JACC Cardiovasc Imaging. 2021 Mar 1;14(3):644-53.

Maron DJ, Hochman JS, Reynolds HR, Bangalore S, O’Brien SM, Boden WE, et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. New England Journal of Medicine. 2020 Apr 9;382(15):1395-407.

Nakanishi R, Gransar H, Slomka P, Arsanjani R, Shalev A, Otaki Y, et al. Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging. Journal of Nuclear Cardiology. 2016 Jun 1;23(3):530-41.

Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, et al. Anatomic versus physiologic assessment of coronary artery disease: Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol. 2013;62(18):1639-53.

Kitkungvan D, Johnson NP, Roby AE, Patel MB, Kirkeeide R, Gould KL. Routine Clinical Quantitative Rest Stress Myocardial Perfusion for Managing Coronary Artery Disease: Clinical Relevance of Test-Retest Variability. JACC Cardiovasc Imaging. 2017;10(5):565-77.

Ziadi MC. Myocardial flow reserve (MFR) with positron emission tomography (PET)/computed tomography (CT): clinical impact in diagnosis and prognosis. Cardiovasc Diagn Ther [Internet]. 2017;7(2):206-18. Disponível em: http://cdt.amegroups.com/article/view/14599/14845

Ziadi MC, Dekemp RA, Williams KA, Guo A, Chow BJW, Renaud JM, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol [Internet]. 2011;58(7):740–8. Disponível em: http://dx.doi.org/10.1016/j.jacc.2011.01.065

Gupta A, Taqueti VR, van de Hoef TP, Bajaj NS, Bravo PE, Murthy VL, et al. Integrated Noninvasive Physiological Assessment of Coronary Circulatory Function and Impact on Cardiovascular Mortality in Patients With Stable Coronary Artery Disease. Circulation. 2017;136(24):2325-36.

Taqueti VR, Di Carli MF. Clinical significance of noninvasive coronary flow reserve assessment in patients with ischemic heart disease. Curr Opin Cardiol. 2016;31(6):662-9.

Henrique de Souza AC do A, Gonçalves BKD, Tedeschi A, de Souza Leão Lima R. Quantification of coronary flow reserve with czt gamma camera in the evaluation of multivessel coronary disease. Arq Bras Cardiol. 2018 Oct 1;111(4):635-7.

de Souza AC do AH, Harms HJ, Martell L, Bibbo C, Harrington M, Sullivan K, et al. Accuracy and Reproducibility of Myocardial Blood Flow Quantification by Single Photon Emission Computed Tomography Imaging in Patients With Known or Suspected Coronary Artery Disease. Circ Cardiovasc Imaging [Internet]. 2022 Jun 8; Disponível em: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.122.013987

Mesquita C. Excess diagnosis in cardiology: the overdiagnosis issue. International Journal of Cardiovascular Sciences. 2015;28(3):163-4.

Eduardo Mastrocola L, Juarez Amorim B, Vicente Vitola J, Soares Brandão SC, Blacher Grossman G, Souza Leão Lima De R, et al. Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020. Arq Bras Cardiol. 2020 Feb 1;114(2):325-428.

Fernandes F de A, Santos AASMD dos, Oliveira A de, Mesquita CT. Challenges and Opportunities in the use of Ionizing Radiation for Cardiovascular Diseases. International Journal of Cardiovascular Sciences. 2019.

Dondi M, Kashyap R, Pascual T, Paez D, Nunez-Miller R. Quality management in nuclear medicine for better patient care: the IAEA program. Semin Nucl Med [Internet]. 2013 May [cited 2014 Jun 22];43(3):167-71. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/23561453

Orellana P, Mut F, Estrada E, Lette MM, Pellet O, Morozova O, et al. Status of Nuclear Medicine in Latin America and the Caribbean: IAEA Analysis of Development in the Past 6 Years.

Rodrigues CVB, Oliveira A, Wiefels CC, Leão M de S, Mesquita CT. Current practices in myocardial perfusion scintigraphy in Brazil and adherence to the IAEA recommendations: Results of a cross-sectional study. Arq Bras Cardiol. 2018 Feb 1;110(2):175-80.

Motwani M, Berman DS, Germano G, Slomka P. Automated Quantitative Nuclear Cardiology Methods. Vol. 34, Cardiology Clinics. W.B. Saunders; 2016. p. 47-57.

Otaki Y, Betancur J, Sharir T, Hu LH, Gransar H, Liang JX, et al. 5-Year Prognostic Value of Quantitative Versus Visual MPI in Subtle Perfusion Defects: Results From REFINE SPECT. JACC Cardiovasc Imaging. 2020 Mar 1;13(3):774-85.

Hu LH, Miller RJH, Sharir T, Commandeur F, Rios R, Einstein AJ, et al. Prognostically safe stress-only single-photon emission computed tomography myocardial perfusion imaging guided by machine learning: Report from REFINE SPECT. Eur Heart J Cardiovasc Imaging. 2021 Jun 1;22(6):705-14.

Nensa F, Demircioglu A, Rischpler C. Artificial intelligence in nuclear medicine. Journal of Nuclear Medicine. 2019 Sep 1;60(9):29S-37S.

Dey D, Slomka PJ, Leeson P, Comaniciu D, Shrestha S, Sengupta PP, et al. Artificial Intelligence in Cardiovascular Imaging: JACC State-of-the-Art Review. Vol. 73, Journal of the American College of Cardiology. Elsevier USA; 2019. p. 1317-35.

Papandrianos NI, Feleki A, Papageorgiou EI, Martini C. Deep Learning-Based Automated Diagnosis for Coronary Artery Disease Using SPECT-MPI Images. J Clin Med. 2022 Jul 1;11(13).

Downloads

Publicado

2024-04-12

Edição

Seção

Artigos de revisão