心筋血流SPECT と冠動脈CT の融合画像

In the image diagnosis of circulatory diseases, various modalities such as chest X-ray (CXR) examination, coronary angiography (CAG), ultra sonography (US), nuclear cardiology, CT (computed tomography), MRI (magnetic resonance imaging), etc. are used depending on the disease and the application thereof. CXR has high versatility and enables observation of the entire chest with one image, while CAG enables direct observation of the coronary artery shape and can be used to carry out revascularization such as percutaneous coronary intervention, etc. following inspection. US is not associated with radiation exposure, it may be repeatedly carried out at bedside, and excels at functional evaluations such as observing the movement of walls and valves, measuring the left ventricular volume, ejection fraction, etc. Function/metabolism information that is difficult to obtain using conventional modalities such as myocardial blood flow and fatty acid metabolism, cardiac sympathetic-nerve, etc. may be obtained by nuclear cardiology ; specifically, myocardial perfusion scintigraphy has a long history and abundant evidence. The application of CT and MRI which excel at morphological evaluation are rapidly spreading with the advancement of machines such as those with multi-detector row CT, the development of ECG gated sequence, etc. Coronary artery CT is becoming actively used in ischemic heart disease as well ; however, the efficacy of nuclear medicine is still high in terms of myocardial perfusion and viability evaluation. When ischemia is observed on myocardial blood flow scintigraphy during routine medical care, it is not rare to struggle in identifying the culprit coronary artery. FDG-PET/CT are important regarding the fused image of function/metabolism images and morphological images upon tumor examination. Investigations into the circulatory organ region are gradually advancing with research and the development of image displaying/analyzing software. 320‐MDCT and heart analyzing software were introduced to Tokushima University Hospital in April, 2012, making possible the creation of fused images of the coronary artery CT and myocardial perfusion single photon emission CT (SPECT). Thereby, the coronary artery shape and myocardial perfusion may be displayed and observed on the same image, allowing more simple and accurate identification of the culprit blood vessel and evaluation of the range and shape of ischemia. In this report, we hereby review the myocardial perfusion SPECT and coronary artery CT, and describe the usability and future outlook of fused images together with our experience at our institute.