Subdiaphragmatic activity-related artifacts in myocardial perfusion scintigraphy

Authors

  • Monika Štalc Division of nuclear medicine, University Medical Centre, Ljubljana

Abstract

Myocardial perfusion imaging (MPI) with single photon emission computed tomography is an established non-invasive technique for assessing myocardial ischemia. This method involves the intravenous administration of a radiopharmaceutical that accumulates in the heart muscle proportional to regional blood flow. However, image quality and diagnostic accuracy can be compromised by various technical and patient-related factors, including high non-specific radiopharmaceutical uptake in abdominal organs such as the stomach, intestines, liver, and gallbladder, leading to subdiaphragmatic artifacts. These artifacts are particularly problematic for evaluating inferior wall perfusion and often necessitate repeated imaging, which decreases gamma camera availability and prolongs imaging times. Despite numerous investigated techniques to reduce interfering gastrointestinal activity, results have been inconsistent, and current MPI guidelines provide scant information on effective procedures to mitigate this issue. This review examines the effects of various interventions aimed at reducing subdiaphragmatic activity to improve the quality and diagnostic value of MPI.

 

Subdiafragmatična aktivnost in z njo povezani artefakti pri perfuzijski scintigrafiji srca

 

Izvleček

 

Perfuzijska scintigrafija srca (PSM) je neinvazivna diagnostična metoda, ki ima pomembno vlogo v diagnostiki ishemične bolezni srca. Po intravenskem vbrizganju radiofarmaka, se ta nakopiči v srčni mišici sorazmerno s področnim krvnim pretokom. Radiofarmak se naspecifično kopiči tudi v trebušnih organih, kar lahko ustvari artefakte. Subdiafragmatična aktivnost predstavlja enega izmed najpogostejših artefaktov in otežuje predvsem ocenjevanje perfuzije spodnje stene srčne mišice in lahko vodi do subotpimalne obravnave pacienta. V klinični praksi je zaradi trebušne aktivnosti potrebno pogosto slikanje na gama kameri ponoviti. S tem se podaljšuje čas trajanja preiskave, zmanjšuje se razpoložljivost gama kamere za druge bolnike in povečuje sevalna obremenitev tako zaposlenih kot pacientov v čakalnici. Rezultati raziskav, v katerih so preučevali različne tehnike za zmanjšanje subdiafragmatične aktivnosti, so nasprotujoči. Zato trenutne smernice za PSM standardiziranega pristopa za učinkovito zmanjšanje tega problema ne določajo.

V tem preglednem članku predstavljamo različne ukrepe, ki so namenjeni zmanjšanju subdiafragmatične aktivnosti za izboljšanje kakovosti in diagnostične vrednosti PSM.

 

 

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Published

2024-09-09

How to Cite

Štalc, M. (2024). Subdiaphragmatic activity-related artifacts in myocardial perfusion scintigraphy. Radiology and Oncology, 58(3), 313–319. Retrieved from https://radioloncol.com/index.php/ro/article/view/4409

Issue

Section

Review