rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2016-97-4-8-15rentrad-158Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS OF LITERATUREСовмещенная однофотонная эмиссионная и рентгеновская компьютерная томография сердца: методические аспектыSuperimposed single-photon emission computed tomography and X-ray computed tomography of the heart: Methodical aspectshttps://orcid.org/0000-0002-1513-8614ЗавадовскийК. В.ZavadovskyK. V.

д. м. н., вед. науч. сотр.,

ул. Киевская, 111А, Томск, 634012,

пр-т Ленина, 30, Томск, 634050

MD, PhD, DSc, Leading Research Associate,

ul. Kievskaya, 111A, Tomsk, 634012,

prospekt Lenina, 30, Tomsk, 634050

konstzav@gmail.comhttps://orcid.org/0000-0001-5689-9754ГуляМ. О.GulyaM. O.

к. м. н., врач-рентгенолог,

ул. Киевская, 111А, Томск, 634012,

пр-т Ленина, 30, Томск, 634050

MD, PhD, Radiologist,

ul. Kievskaya, 111A, Tomsk, 634012,

prospekt Lenina, 30, Tomsk, 634050

https://orcid.org/0000-0001-5564-3802СаушкинВ. В.SaushkinV. V.

к. м. н., мл. науч. сотр.,

ул. Киевская, 111А, Томск, 634012

MD, PhD, Junior Research Associate,

ul. Kievskaya, 111A, Tomsk, 634012

https://orcid.org/0000-0002-0193-9453СаушкинаЮ. В.SaushkinaYu. V.

к. м. н., врач-радиолог,

ул. Киевская, 111А, Томск, 634012

MD, PhD, Radiologist,

ul. Kievskaya, 111A, Tomsk, 634012

https://orcid.org/0000-0001-7324-504XЛишмановЮ. Б.LishmanovYu. B.

д. м. н., профессор, чл.-корр. РАН, руководитель научного направления НИИ кардиологии,

ул. Киевская, 111А, Томск, 634012,

пр-т Ленина, 30, Томск, 634050

MD, PhD, DSc, Professor, Corresponding Member of Russian Academy of Sciences, Head of the Scientific Direction,

ul. Kievskaya, 111A, Tomsk, 634012,

prospekt Lenina, 30, Tomsk, 634050

ФГБНУ «Томский национальный исследовательский медицинский центр РАН “Научно-исследовательский институт кардиологии”»; ФГАОУ ВО «Национальный исследовательский Томский политехнический университет»РоссияCardiology Research Institute; National Research Tomsk Polytechnic UniversityRussian FederationФГБНУ «Томский национальный исследовательский медицинский центр РАН “Научно-исследовательский институт кардиологии”»РоссияCardiology Research InstituteRussian Federation201613092016974235242Copyright © Завадовский К.В., Гуля М.О., Саушкин В.В., Саушкина Ю.В., Лишманов Ю.Б., 20162016Завадовский К.В., Гуля М.О., Саушкин В.В., Саушкина Ю.В., Лишманов Ю.Б.Zavadovsky K.V., Gulya M.O., Saushkin V.V., Saushkina Y.V., Lishmanov Y.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/158

За последнее время в области мировой радиологии и ядерной медицины наметился явный тренд к выполнению гибридных (комбинированных, совмещенных) исследований. К сожалению, в отечественной литературе практически отсутствуют работы как методического, так и исследовательского характера по данной тематике. В основу данной статьи легли рекомендации Североамериканского общества ядерной медицины и молекулярных изображений, Североамериканского общества ядерной кардиологии, Общества сердечно-сосудистой компьютерной томографии, а также принципы, изложенные в совместной позиции Европейского общества ядерной медицины, Европейского радиологического общества, Европейского совета по ядерной медицине. Целью статьи является знакомство читателей с некоторыми методическими аспектами выполнения совмещенной однофотонной эмиссионной и рентгеновской компьютерной томографии сердца (ОФЭКТ/КТ). В данной публикации обсуждаются основные показания и противопоказания к выполнению гибридных кардиологических исследований, а также приводятся другие сведения, полезные при отборе пациентов на исследование. Рассказывается о подготовке пациента и мерах предосторожности. Дана информация об основных радиофармпрепаратах и оборудовании для совмещенных исследований. Приведены параметры записи изображений, сведения о коррекции поглощения гамма-квантов по данным КТ. Затронута тема интерпретации результатов определения кальциноза коронарных артерий, КТ-коронарографии и перфузионной сцинтиграфии миокарда. Приведены методические аспекты совмещения радионуклидного и КТ-изображений, возможные источники ошибок при выполнении совмещенного ОФЭКТ/КТ-исследования, а также рекомендации по формированию диагностического заключения. Обсуждаются вопросы лучевой нагрузки и радиационной безопасности.

Global radiology and nuclear medicine have recently shown a clear trend towards hybrid (combined, superimposed) studies. Unfortunately, the Russian literature virtually lacks both methodological and research works on this topic. The basis for this paper was the guidelines of the North American Society of Nuclear Medicine and Molecular Imaging, the North American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography and the principles as jointly set out by the European Society of Nuclear Medicine, the European Society of Radiology, and the European Association of Nuclear Medicine.

The purpose of the paper is to familiarize readers with some methodical aspects of performing superimposed single-photon emission computed tomography (SPECT) and X-ray computed tomography (CT) of the heart. This publication discusses the main indications for and contraindications to hybrid cardiological studies and gives other data that are useful to select patients for examination. A patient's preparation and prevention measures are described. There is information on major radiotracers and equipment for superimposed studies. There are imaging parameters and information on the correction of gamma-ray quantum absorption according to CT data. The paper concerns the interpretation of the results of identifying coronary artery calcification and those of CT coronarography and myocardial perfusion scintigraphy. It presents the methodical aspects of superimposition of radionuclide and CT images, the possible sources of errors during superimposed SPECT/CT, and recommendations for making a diagnostic conclusion. The issues of radiation load and radiation safety are discussed.

миокардкоронарные артерииперфузияоднофотонная эмиссионная компьютерная томография/компьютерная томографиясовмещениекоррекция поглощенияmyocardiumcoronary arteriesperfusionsingle-photon emission computed tomography/computed tomographysuperimpositionabsorption correctionРоссийский научный фондReferencesКороткевич А.А., Коков А.Н. Гибридные технологии лучевой диагностики ишемической болезни сердца: современные возможности и перспективы. Комплексные проблемы сердечно-сосудистых заболеваний. 2015; 1: 5–9. [Korotkevich A.A., Kokov A.N. Hybrid technologies of radiation diagnostics of ischemic heart disease: current possibilities and perspectives. Kompleksnye Problemy Serdechnososudistykh Zabolevaniy (Complex Problems of Cardiovascular Diseases, Russian journal). 2015; 1: 5–9 (in Russ.).]Короткевич А.А., Коков А.Н. Гибридные технологии лучевой диагностики ишемической болезни сердца: современные возможности и перспективы. Комплексные проблемы сердечно-сосудистых заболеваний. 2015; 1: 5–9. 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Imaging. 2005; 32 (7): 855–97.Hesse B., Tägil K., Cuocolo A., Anagnostopoulos C., Bardiés M., Bax J. et al. EANM/ESC Group. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur. J. Nucl. Med. Mol. Imaging. 2005; 32 (7): 855–97.Dorbala S., Di Carli M.F., Delbeke D., Abbara S., DePuey E.G., Dilsizian V. et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J. Nucl. Med. 2013; 54 (8): 1485–507.Dorbala S., Di Carli M.F., Delbeke D., Abbara S., DePuey E.G., Dilsizian V. et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J. Nucl. Med. 2013; 54 (8): 1485–507.Flotats A., Knuuti J., Gutberlet M., Marcassa C., Bengel F.M., Kaufmann P.A. et al. Hybrid cardiac imaging: SPECT/CT and PET/CT – a joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur. J. Nucl. Med. Mol. Imaging. 2011; 38: 201–12.Flotats A., Knuuti J., Gutberlet M., Marcassa C., Bengel F.M., Kaufmann P.A. et al. Hybrid cardiac imaging: SPECT/CT and PET/CT – a joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur. J. Nucl. Med. Mol. Imaging. 2011; 38: 201–12.Holly T.A., Abbott B.G., Al-Mallah M., Calnon D.A., Cohen M.C., Di Filippo F.P. et al. Single photonemission computed tomography. American Society of Nuclear Cardiology (ASNC) Imaging Guidelines For Nuclear Cardiology Procedures. J. Nucl. Cardiol. 2010; 17 (5): 941–73.Holly T.A., Abbott B.G., Al-Mallah M., Calnon D.A., Cohen M.C., Di Filippo F.P. et al. Single photonemission computed tomography. American Society of Nuclear Cardiology (ASNC) Imaging Guidelines For Nuclear Cardiology Procedures. J. Nucl. Cardiol. 2010; 17 (5): 941–73.Rodgers G.P., Ayanian J.Z., Balady G., Beasley J.W., Brown K.A., Gervino E.V. et al. American College of Cardiology/American Heart Association clinical competence statement on stress testing: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. Circulation. 2000; 102: 1726–38.Rodgers G.P., Ayanian J.Z., Balady G., Beasley J.W., Brown K.A., Gervino E.V. et al. American College of Cardiology/American Heart Association clinical competence statement on stress testing: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. Circulation. 2000; 102: 1726–38.Mark D.B., Berman D.S., Budoff M.J., Carr J.J., Gerber T.C., Hecht H.S. et al. ACCF/ACR/ AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010; 121: 2509–43.Mark D.B., Berman D.S., Budoff M.J., Carr J.J., Gerber T.C., Hecht H.S. et al. ACCF/ACR/ AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010; 121: 2509–43.Abbara S., Arbab-Zadeh A., Callister T.Q., Desai M.Y., Mamuya W., Thomson L. et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J. Cardiovasc. Comput. Tomogr. 2009; 3: 190–204.Abbara S., Arbab-Zadeh A., Callister T.Q., Desai M.Y., Mamuya W., Thomson L. et al. SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J. Cardiovasc. Comput. Tomogr. 2009; 3: 190–204.Kloner R.A. Pharmacology and drug interaction effects of the phosphodiesterase 5 inhibitors: focus on alpha-blocker interactions. Am. J. Cardiol. 2005; 96 (12B): 42M–46M.Kloner R.A. Pharmacology and drug interaction effects of the phosphodiesterase 5 inhibitors: focus on alpha-blocker interactions. Am. J. Cardiol. 2005; 96 (12B): 42M–46M.Chang S.M., Nabi F., Xu J., Raza U., Mahmarian J.J. Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. J. Am. Coll. Cardiol. 2010; 55: 221–30.Chang S.M., Nabi F., Xu J., Raza U., Mahmarian J.J. Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. J. Am. Coll. 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The authors declare that there are no conflicts of interest present.