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|本期目录/Table of Contents|

201Tl静息-再分布显像后行再注射心肌断层显像检测存活心肌的价值(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
1999年第2期
页码:
85-87,90
栏目:
论著
出版日期:
1999-03-01

文章信息/Info

Title:
Assessment of myocardial viability by reinjection imaging after rest-redistribution 201Tl imaging
作者:
李京波1X 李志善1 　黄 钢2 　朱　伟3 　陈可靖2
上海医科大学中山医院　1心内科　2核医学科　3心超室 上海 200032
Author(s):
Li Jingbo1; Li Zhishan1;  Huang Gang2;  Zhu Wei3;  Chen Kejing2
Zhongshan Hospital, Shanghai Medical University, Shanghai 200233
关键词:
心肌梗死　放射性核素显像　铊　断层摄影术;  发射型计算机;  单光子
Keywords:
myocardial infarction　radionuclide imaging　thallium 　tomography;  emission-computed;  single photon
分类号:
-
DOI:
-
文献标识码:
-
摘要:
为评价201Tl静息-再分布显像后行再注射显像检测存活心肌的价值, 对24例心肌梗死患者行201Tl静息-再分布2-再注射显像。8例经皮穿刺腔内冠状动脉成形术(PTCA) 的患者术前及术后2周～4周随访了超声心动图。结果显示201Tl静息显像有97个心肌节段放射性摄取异常, 其中4 h再分布显像有可逆性灌注缺损31个节段, 再注射显像均为可逆性缺损; 再分布显像为不可逆性灌注缺损的66个节段, 其中9个节段(13。64% )再注射显像表现为再充填。201Tl静息-再分布显像和201Tl静息-再分布-再注射显像预测PTCA术后心肌灌注改善的阳性预测值分别为77。78% 和80。95% , 阴性预测值分别为77。78% 和93。33%。201Tl静息-再分布显像和201Tl静息-再分布-再注射显像预测存活心肌的准确性分别为77。78% 和86。11%。因此201Tl静息-再分布显像后行再注射显像可提高对部分存活心肌的检出。这种显像方案尤其适合于伴严重左室功能障碍和运动试验有禁忌证的患者的存活心肌的评价。
Abstract:
A study was carried out to evaluate the clinical value of reinjection imaging after restredistribution 201Tl imaging in detecting viable myocardium in myocardial infarction。24 patients with myocardial infarction underwent reinjection imaging after rest-redistribution 201Tl imaging.Eight patients were followed up by echocardiography before and two to four weeks after percuta-neous transluminal coronary angioplasty(PTCA).The results showed that on rest 201Tl imaging,97 segments had abnormal uptake, of which 31 segments were identified with reversible perfusion defects by means of both 4h redistribution imaging and reinjection imaging after rest-redistribu-tion imaging.Of the 66 segment swith irreversible defects identified by redistribution imaging, 9(13.64%) had increased uptake by reinjection imaging.In the eight patients studied before and after PTCA , the positive predictive values for myocardial viablity (wall motion improved after PTCA) were 77.78% and 80.95% and the negative predictive values were 77.78% and 93.33% by rest-redistribution and rest-redistribution-reinjection 201Tl imaging respectively.The predictive accuracies were 77.78% and 86.11% by rest-redistribution and rest-redistribution-reinjection 201Tl imaging respectively.So reinjection imaging after rest-redistribution 201Tl imaging improves the detection of a part of viable myocardium , the technique may be used for identifying viable myocardium , especially in the patients with severe left ventricular dysfunction and contraindications to stress testing.

参考文献/References

［1］Bonow RO ,Dilsizian V , Cuocolo A , et al.Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction: comparison of thallium scintigraphy with reinjection and PET imaging with 18F-fluorodeoxyglucose.Circulation, 1991; 83:26.

［2］Dilsizian V , Rocco TP,Freedman MNT, et al.Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging.N Engl J Med , 1990;323: 141.

［3］Ohtani H, Tamaki N , Yone kura Y, et al.Value of thallium-201 reinjection after delayed SPECT imaging for predicting reversible ischemia after coronary artery bypass grafting.Am J Cardiol,1990; 66: 394.

［4］ Berger BC, Watson DD, Burwell LR, et al.Redistribution of thallium at rest in patients with stable and unstable angina and the effect of coronary artery bypass surgery.Circulation, 1979;60: 1114.

［5］ Iskandrian AS, Hakki A , Kane SA , et al.Rest and redistribution thallium-201 myocardial scintigraphy to predict improvement in left ventricular function after coronary arterial bypass grafting.Am J Cardiol, 1983; 51: 1312.

［6］Mori T,Minamiji K, Kurogane H, et al.Rest injected thallium-201 imaging for assessing viability of severe asynergic regions.J Nucl Med , 1991; 32: 1718.

[7]Dilsizian V , Perrone-filardi P,Arrighi JA , et al.Concordance and discordance between stress-redistribution-reinjection and rest-redistribution thallium imaging for assessing viable myocardium: Comparison with metabolic activity by positron emission tomography.Circulation, 1993; 88: 941.

[8]Braunwald E, Rutherford JD.Reversible ischemic left ventricular dysfunction: evidence for“hibernating”myocardium.J Am Coll Cardiol, 1986; 8: 1467.

[9]Gibson RS,Watson DD, Taylor GJ , et al.Prospective assessment of regionalmyocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy.J Am Coll Cardiol, 1983; 1: 804.

[10]Rocco TP, Dilsizian V ,Mckusick KA , et al.Comparison of thallium redistribution with rest“reinjection”imaging for the detection of viable myocardium.Am J Cardiol, 1990; 66: 158.

备注/Memo

备注/Memo:
(收稿1998-06-01　修回1998-11-09)现在上海市第六人民医院心内科 200233
更新日期/Last Update: 1999-03-01