一日法99Tcm-替曲膦运动-静息门控心肌灌注显像的临床研究

目的 探讨使用亚锡替曲膦药盒能否得到满足临床需要的99Tcm-替曲膦(TF)以及1d内完成99Tcm-TF运动-静息G-MPI的可行性.方法 回顾性分析52例行99Tcm-TF运动-静息G-MPI且均有CAG结果的受试者资料.标记亚锡替曲膦并进行放化纯检测.1d内对受试者分别在运动负荷及静息状态下静脉注射99Tcm-TF 370和740 MBq,30 min时行G-MPI.2次注射显像剂间隔时间为(129±4)min.运动负荷状态下注射99Tcm-TF后加行1～ 30 min前位胸腹部平面动态显像和2h前位平面显像.用ROI技术分析胸腹部平面动态像,得到左室心肌、肝及胸部放射性变化情况；用Cedars心肌定量分析软件分析左室心肌各节段灌注情况及左室功能参数(LVEF、EDV、ESV等).1周内行超声心动图检查,获取LVEF、EDV和ESV.对运动-静息G-MPI(取2次显像平均值)心功能参数与超声心动图结果采用SPSS 17.0进行配对t检验.结果 99Tcm-TF放化纯为(97.5±0.4)％.G-MPI左室心肌显影清晰；动态显像示左室心肌与肝放射性比值12 min后逐渐增大,30 min时达0.710,2h延迟显像左室心肌内放射性基本清除.以CAG为“金标准”,G-MPI诊断心肌缺血的灵敏度为84.6％ (22/26),特异性为92.3％(24/26)；G-MPI与超声心动图测定的LVEF、EDV和ESV分别为(60.27±7.49)％和(60.84±5.98)％,(97.82±18.98)ml与(98.70-±17.89) ml,(47.67 ±10.32) ml与(45.49 ±10.15) ml,差异均无统计学意义(t=1.254、0.835和0.981,P均＞0.05).结论 采用亚锡替曲膦药盒标记得到的99Tcm-TF能够满足临床需要；99Tcm-TF能够在1d内完成运动负荷及静息G-MPI,可作为常规评价心肌灌注及左室功能的显像剂.

The feasibility of ^99Tc^m-tetrofosmin gated myocardial perfusion imaging with one-day stress/rest protocol

Objective - To investigate the feasibility of ^99Tc^m,tetrofosmin G-MPI with a one-day stress/rest protocol in subjects suspected with coronary heart disease （CHD）. Methods Fifty-two subjects who had undertaken^99Tc^m-tetrofosmin myocardial SPECT and CAG because of suspected CHD were retro- spectively analyzed. The patients were divided into a coronary artery stenosis group and a normal group ac- cording to CAG results. Exercise and rest G-MPI was performed using a one-day protocol with the interval of exercise and rest imaging at （ 129 ±4） min. SPECT acquisition started at about 30 min after tracer adminis- tration. In addition, during stress imaging, dynamic anterior planar imaging （from 1 - 30 min after tracer injection） and a planar image at 2 h were acquired. Radioactivity in the left ventricle myocardium, liver and chest was analyzed using ROI technology. Left ventricle myocardial segment perfusion and left ventricle function were evaluated with Cedars myocardial quantitative assessment software. The parameters of left ven- tricle function （LVEF, EDV and ESV） obtained from G-MPI were compared with that from ultrasonic cardi- ogram using a paired t test. CAG was used as the gold standard to evaluate the diagnostic efficacy of G-MPI for coronary diseases. Results Radiochemical purity of ^99Tc^m-tetrofosmin was （97.5 ± 0.4） %. The imagequality of myocardial SPECT was satisfactory. Radioactivity ratio of the left ventricular myocardium to the liver increased from 12 min after tracer injection and reached a peak （0. 710） at 30 min. Left ventricular myocardium was not visualized at the 2 h planar image. The diagnostic sensitivity and specificity of G-MPI for detecting coronary lesions was 84.6% （22/26） and 92.3% （24/26）, respectively. LVEF, EDV and ESV parameters from G-MPI were comparable with those of ultrasonic cardiogram （ LVEF： （60. 27 ± 7.49） % vs （60.84±5.98）%, t =1.254; EDV： （97.82±18.98） ml vs （98.70±17.89） ml, t =0.835; ESV： （47.67±10.32） mlvs （45.49±10.15） ml, t=0.981, allP〉0.05）. Conclusions ^99Tc^m-tetrofosmin is easy to prepare with a stable radiochemical quality. A one-day protocol of stress/rest G-MPI with ^99Tc^m- tetrofosmin may be feasible and effective in detecting myocardial ischemia and evaluating left ventricular function.