Detection of stunned myocardium in post-reperfusion cases of acute myocardial infarction

OBJECTIVE: This study was designed to evaluate the correlation between improvements in serial images obtained by SPECT imaging with Tc-99m MIBI (MIBI) and I-123 BMIPP (BMIPP) and the recovery of cardiac function in acute myocardial infarction (AMI) patients after reperfusion therapy. METHODS: Twenty five patients who were admitted to the emergency room within 24 hours after the onset of the first event of AMI were enrolled in this study. The culprit coronary arteries were identified by CAG and were treated with direct percutaneous transluminal coronary angiography (PTCA), followed by stent implantation. To determine risk areas, initial image at the onset was acquired by the freeze method, in which MIBI was injected before the treatment and the image was collected after the reperfusion therapy. After the reperfusion treatment was completed, MIBI SPECT images at rest were performed on days 7 and 60. Both early and late images, including gated SPECT images were acquired after 30-60 minutes and 6 hours post injection, respectively. In addition, BMIPP SPECT images at rest were obtained 30 minutes after injection of 148 MBq BMIPP on days 7 and 60 (BMIPP image). The obtained image was divided into 48 segments and percent uptake of each segment was calculated. The number of abnormal areas (NAA) was defined as the segment with a % uptake less than 60% of normal uptake, and the change of NAA over time was evaluated. RESULTS: The NAA on the MIBI-early image significantly improved between thepre image and the day 7 image (p < 0.001), but no similar improvement was observed between day 7 and day 60. On the other hand, the NAA of the MIBI-delayed image did not significantly improve up to day 7, but a slight improvement was observed on days 7 and 60 (p < 0.05). A significant improvement in the NAA of the BMIPP image was observed between day 7 and day 60, as shown in the delayed image (p < 0.05). An excellent correlation on the NAA between the MIBI-delayed image and the BMIPP image was observed with r = 0.983 (p < 0.001) at day 7 and r = 0.984 (p < 0.001) at day 60 resulting in a consistent diagnosis. Analysis of the myocardial function by means of gated SPECT indicated that the wall motion significantly improved as the myocardial perfusion improved up to day 7 and thereafter a steady improvement was observed up to day 60. The improvement in the NAA in MIBI-delayed images in the subacute phase (day 7) and in the chronic phase (day 60) as well as BMIPP images showed excellent correlation with the improvement in RWM and RWT (MIBI-delayed image: r = 0.550 (RWM), r = 0.647 (RWT)), (BMIPP image: r = 0.536 (RWM), r = 0.565 (RWT)). CONCLUSION: We conclude that insufficient ATP production caused by mitochondrial dysfunction in stunned myocardium is closely related to MIBI delayed and BMIPP image Furthermore, MIBI delayed imaging as well as BMIPP imaging will provide a clue to the state of stunned myocardium after reperfusion therapy in patients with AMI.     

^99mTc-MIBI甲状腺显像半定量分析鉴别甲状腺结节的价值

目的评价99mTc-MIBI甲状腺显像半定量分析法鉴别甲状腺结节的价值.材料和方法36例Na99mTcO4甲状腺显像为单发"冷结节"患者,行99mTc-MIBI甲状腺双时相显像,分别计算15和120min甲状腺结节摄取比值(ER、DR),以良性结节组的DR均值+标准差(0.90+0.21)为诊断恶性病变的阈值.结果手术证实良性病变22例,ER与DR值分别为0.89±0.33、0.90±0.21,恶性病变14例,ER和DR值分别为1.16±0.51、1.34±0.64,ER值两组间比较无差异(p＞0.05),DR两组间比较有显著性差异(p＜0.01).99mTc-MIBI甲状腺显像DR值诊断良恶性病变的灵敏度85.7%,特异性86.4%,阳性预测值80.0%,阴性预测值90.5%.结论99mTc-MIBI甲状腺显像半定量分析能较好的鉴别甲状腺结节的性质,DR比ED更有价值.     

心肌灌注显像及其半定量分析在冠状动脉成形术的应用评价

评价心肌灌注SPECT对于经皮冠状动脉腔内成形术(PTCA)的应用意义.对18例冠心病患者(分为心肌梗死组和非心肌梗死组)在PTCA前后进行运动-静息99mTC-MIBI SPET显像动态观察,并对图像进行半定量分析,如缺血面积、梗死灶边缘带摄取比值(border zone uptake,BZU)等.结果发现运动-静息99mTc-MIBI心肌灌注SPECT结合定量分析对于PTCA术前病例选择和疗效预测;"罪犯"血管的确定;术后近期疗效的客观评价以及远期随访可提供一个可靠的无创方法.     

心脏ECT展开图评价异舒吉和硝酸甘油抗心肌缺血作用

目的　评价比较 ２ 种药物异舒吉和硝酸甘油抗心肌缺血作用。方法　利用９９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ灌注断层显象展开图比较药物治疗前后左室缺血面积的改善情况，用面积的改善反映药物的抗心肌缺血作用。结果　异舒吉治疗前后缺血心肌面积分别为３２５９７± ６２９５ ｃｍ ２ 、２８６７３ ±３１３１ ｃｍ ２， 治 疗前 后缺血 面积 与左 室面 积的 百分 比分别 为 １７２５４％ ±５６１４％ 、１５４０１％ ±２７８０％ ；硝酸甘油治疗前后缺血面积分别为 ３２１２６ ±５４７８ ｃｍ ２ 、２９７０２±２９８２ ｃｍ ２， 缺血面积与左室面积 的百分比分别为１６９８９％ ±５６１４％ 、１５９２３％ ±２７８０％ （ Ｐ＜ ００５）。治疗前后，异舒吉组的缺血面积改善程度与硝酸甘油组相比无差异（ Ｐ ＞００５）。结论　异舒吉和硝酸甘油均有抗心肌缺血作用，临床医生需要注意“成本效果分析     

放射性核素心肌显像评价大动脉炎心脏受累

目的 评价放射性核素心肌显像在大动脉炎心脏受累患者中的应用价值.方法 回顾性分析12例临床确诊大动脉炎且有心脏受累,并接受了放射性核素心肌显像和冠状动脉造影患者的临床和心肌显像资料.12例患者中,男3例,女9例,年龄(35±15)岁.将12例患者的心脏受累分为单纯主动脉瓣受累(4例)和冠状动脉受累而无主动脉瓣受累(8例).单纯主动脉瓣受累的患者中,运动和药物负荷99Tcm-甲氧基异丁基异腈(MIBI)心肌灌注显像各1例,另2例进行了静息心肌灌注显像;冠状动脉受累的患者中,4例进行了心肌灌注显像(运动和药物负荷心肌灌注显像各1例,静息心肌灌注显像2例),另外4例进行了99Tem-MIBI和16F-脱氧葡萄糖(FDG)双核素心肌灌注-代谢显像.结果 单纯主动脉瓣受累的4例患者心肌灌注显像表现为左心室扩大,无明显的心肌灌注异常.冠状动脉受累的8例患者中,2例有可逆性心肌缺血,其余6例静息显像即有灌注受损,灌注受损的心肌可存活或不存活.结论 对于大动脉炎心脏受累的患者,放射性核素心肌显像可提供心室形态、心肌灌注和活力等方面的综合信息.     

扩张型心肌病和缺血性心肌病心肌灌注,代谢及功能的综合评价

目的 探讨核素显像在扩张性心肌病（ＤＣＭ）的缺血性心肌病（ＣＡＤ－ＤＭ）诊断及鉴别诊断中的作用。方法 对２８例ＤＣＭ和５５例ＣＡＤ－ＣＭ均行＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）静息心肌灌注ＳＰＥＣＴ及＾１８Ｆ－脱氧葡萄糖（ＦＤＧ）心肌代谢ＰＥＴ显像，其中７３例行核素心室显像，６８例做冠状动脉造影。结果 心肌灌注显像２３例（８２％）ＤＣＭ为不呈节段分布的、散在的稀疏，４例（１４％）有灌注缺损     

乳腺显像装置在99Tcm-MIBI乳腺显像中的多中心应用

目的：探讨乳腺显像装置对^99Tc^m-甲氧基异丁基异腈（MIBI）乳腺显像诊断乳腺肿块的价值。方法：多医疗中心采用广东省人民医院设计的乳腺显像装置行^99Tc^m-MIBI乳腺显像，采用特殊俯卧位检查。721例受检查^99Tc^m-MIBI乳腺显像结果均与病理检查资料对照。其中行B超检查137例，红外线检查86例，针吸细胞学检查112例。结果：^99Tc^m-MIBI乳腺显像、B超、红外线检查、针吸细胞学检查对乳腺肿块诊断的灵敏度分别为92．28％、75．44％、69．44％、80．90％，特异性分别为87．0％、75．00％、54．00％、100％。结论：应用该显像装置的^99Tc^m-MIBI乳腺显像对诊断乳腺肿块有较高的灵敏度和特异性。     

双核素阳性显像评价肺癌原发耐药

目的探讨99Tcm-甲氧基异丁基异腈(MIBI)和201Tl双核素阳性显像评估原发性肺癌原发耐药的可靠性.方法对80例原发性肺癌患者行99Tcm-MIBI 和201Tl 肺双核素SPECT显像,定量计算99Tcm-MIBI和201Tl早期及延迟显像的摄取比值、清除率和残留比值,并进行临床化疗前后比较.化疗疗效判断标准显效病灶缩小>50%;改善病灶缩小30%～50%;无效病灶缩小<30%或不缩小;恶化病灶扩展.结果①201Tl各参数与化疗疗效无明显相关性.②以心肌为本底的延迟显像99Tcm-MIBI摄取比值、清除率及残留比值对化疗疗效评估好于以对侧肺为本底的相应参数.99Tcm-MIBI残留比值稳定,显效、改善、无效、恶化组分别为0.24±0.08、0.20±0.11、0.16±0.08、0.14±0.05.③以99Tcm-MIBI清除率>20%为耐药阳性阈值时,阳性预测值、阴性预测值最佳,分别为71.2%和64.3%;以99Tcm-MIBI残留比值<0.21为耐药阳性阈值时,阳性预测值、阴性预测值最佳,分别为79.3%和72.7%.结论 99Tcm-MIBI 肺阳性显像对原发性肺癌耐药判断可靠性高,其残留比值为肺癌耐药判断的最佳参数.     

放射自显影术用于细胞水平微吸收剂量分布研究

目的：研究放射性药物在小鼠肝脏细胞的微吸收剂量分布，试图建立估算的数学模式。方法：采用冰冻切片光阄放射自显影技术，研究99Tc^m－甲氧基异丁基异腈（MIBI）在小鼠肝脏细胞内细胞水平的分布。结果：99Tc^m－MIBI在肝脏细胞水平的分布是不均匀的，肝细胞核微吸收剂量数值与利用医学内照射剂量（MIBI）模式估算的结果差异较大。结论：该方法不仅可弥补MIRD模式的不足，而且可评估临床放射性药物治疗效果及剂量数据。     

脑膜瘤99Tcm-MIBI与99Tcm-ECD SPECT脑显像的对照研究

目的探讨脑膜瘤99Tcm-MIBI 和99Tcm-ECD SPECT 脑显像的影像特征,并评价其应用价值.方法对10例正常对照者及18例脑膜瘤患者进行99Tcm-MIBI和99Tcm-ECD SPECT脑显像;分析病灶的影像特征.结果正常对照者99Tcm-MIBI显像脑实质内均无核素浓聚;99Tcm-ECD 显像脑实质内放射性核素分布大致均匀,左右侧基本对称.18例脑膜瘤99Tcm-MIBI显像见肿瘤处均表现为均匀的圆形或卵圆形放射性核素浓聚,其阳性率为100%;而99Tcm-ECD显像18例中有17例示肿瘤处表现为形态规整、边缘整齐的圆形或卵圆形内凹缺损,其形态与99Tcm-MIBI显像所示的浓聚区相吻合,另1例为假阴性结果,其阳性率为94.4%.结论 99Tcm-MIBI结合99Tcm-ECD SPECT脑显像可用于脑膜瘤的辅助诊断.