双核素心肌显像检测存活心肌的对比研究

目的 对比多巴酚丁胺负荷201Tl/静息99Tcm-甲氧基异丁基异腈(MIBI)双核素同步心肌断层显像及多巴酚丁胺负荷-再分布/再注射201Tl心肌断层显像法检测存活心肌的作用.方法 对160例临床怀疑有冠心病的患者予静息状态下静脉注射740 MBq99Tcm-MIBI,休息15 min后进行多巴酚丁胺负荷试验,在达到终止指标时静脉注射111 MSq201TICI.注射后观察5-lO min,分别行早期(10 min)、延迟(3 h)99Tcm-MIBI和201Tl双核素同步心肌断层显像.对早期负荷201Tl图像发现放射性缺损,延迟再分布201Tl和静息99Tcm-MIBI图像未见放射性填充的患者再注射37 MBq201TICI,30min后行再注射心肌灌注显像.负荷枷201Tl图像示放射性缺损,静息99Tcm-MIBI、再分布201Tl及再注射201Tl图像中发现任何一种放射性填充者均为存活心肌.断层显像后2周内全部患者进行了冠状动脉造影.采用SAS 6.12软件进行x2检验.结果 (1) 160例患者冠状动脉造影均发现冠状动脉狭窄.其中单支病变76例、双支病变5l例、三支病变33例.(2)152例多巴酚丁胺负荷201Tl图像发现放射性缺损的患者中,63例201Tl再分布和静息99Tcm-MIBI图像均发现放射性填充,5例201Tl再分布发现放射性填充而静息99Tcm-MIBI图像未见放射性填充,9例静息99Tcm-MIBI图像发现放射性填充而2001Tl再分布未见放射性填允,75例201Tl再分布和静息99Tcm-MIBI图像均未发现放射性填充,负荷201Tl-延迟再分布显像(66.0%,68/103)和负荷201Tl/静息99Tcm-MIBI显像(69.9%,72/103)鉴别存活心肌的灵敏度差异无统计学意义(x2=O.36,P>0.05).(3)75例201Tl再分布和静息99Tcm-MIBI图像均未发现放射性填充患者中,再注射201Tl显像后有26例放射性填充,再注射201Tl显像较单纯201Tl再分布或静息99Tcm-MIBI显像多检测出34.7%(26/75)患者有存活心肌.(4)8例多巴酚丁胺负荷201Tl、201Tl再分布图像和静息99Tcm-MIBI图像均未发现放射性稀疏,为假阴性,其中3例为三支冠状动脉病变,1例为双支冠状动脉病变(狭窄分别为90%及60%),3例为单支冠状动脉病变(狭窄<75%2例,85%1例),1例冠状动脉闭塞后有充分的侧枝循环.结论 多巴酚丁胺负荷-再分布/再注射201Tl心肌断层显像鉴别存活心肌优于多巴酚丁胺负荷201Tl/静息99Tcm-MIBI双核素同步心肌断层显像,是一种有效、无创的鉴别存活心肌的方法.

The comparison of simultaneous dual-isotopic myocardial perfusion SPECT imaging in the detection of myocardial viability

Objective The comparison of the clinical role of stress-redistribution/reinjection with dual isotopes of 99Tcm-methoxyisobutylisonitrile (MIBI) and 201TI in the detection of myocardial viability.Methods One hundred and sixty patients with clinically suspicious coronary artery disease (CAD) were included.All had intravenous injection with 740 MBq of 99Tcm-MIBI.Pharmacological challenge with dobu-macological challenge with dobutamin,111 MBq of 201Tl Was injected to all.Myocardial SPECT images were performed in all at 10-min (stress) and 3-h (redistribution/rest) after injection.The 201Tl(37 MBq)would be given to those patients with myocardial perfusion defect at stress images by 201Tl and were demon-strated by both 201Tl(redistribution) and 99Tcm-MIBI (rest).Coronary angiography (CAG) Was performed within two weeks.X2-test was used with SAS 6.12.Results Coronary artery abnormalities were found in all with 76 patients had one vessel disease,51 had two and 33 had three.Of the 152 patients who had myo- cardial perfusion defect during stress images,63 had redistribution by both 201TI and 99Tcm-MIBI.5 had re-distribution by 201Tl only.9 had redistribution by 99Tcm-MIBI only,and 75 had no redistribution in 201Tl or 99Tcm-MIBI images.The sensitivity of detection myocardial viability with myocardial SPECT images between 201Tl at redistribution (66.0%,68/103) and 99Tcm-MIBI at rest (69.9%,72/103) were insignificant (x2=O.36.P>0.05).Of the 75 patients who did not have redistribution in 201Tl or 99Tcm-MIBI images.34.7% (26/75)had myocardial perfusion when reinjection of 201Tl.In all,there were eight false negative myocardial perfusion SEPCT images.Three were triple vessel disease,one Was two, three were one, and the other was patent collateral circulation.Conclusions Stress.redistributed/reinjection 201TI myocardial perfusion SPECT imaging is superior to stress 201Tl/rest 99Tcm-MIBI simultaneous dual-isotopic myocardial imaging in the detec-tion of myocanrdial viability.