99mTc-MIBI 心肌断层显像评价急性心肌梗塞后左心室重构

目的应用９９ｍＴｃ－ＭＩＢＩ静息心肌显像评价心肌梗塞后左心室重构。方法对７６例急性心肌梗塞患者的局部及整体左心室重构进行了９９ｍＴｃ－ＭＩＢＩ静息心肌显像评价，其中４２例为非门控静息心肌显像，３４例为门控静息心肌显像，９９ｍＴｃ－ＭＩＢＩ静息心肌断层显像于发病后平均１２ｈ、１～２周、１～３月分别进行。结果左心室重构的显像表现为梗塞膨展：室壁变薄（７２／７６），室壁拉长（５８／７６），局部扩张（５５／７６）及局部变形（５１／７６）；非梗塞心肌的重构：室壁变厚（３６／７６）及室壁拉长（４９／７６）；左心室整体变形（３５／７６）及左心室整体扩张（４２／７６）。将左心室重构分为３度：Ⅰ度（２５／７６），无左心室整体变形及整体扩张；Ⅲ度（３１／７６），有左心室整体变形及整体扩张；Ⅱ度（２０／７６），介于Ⅰ度与Ⅲ度之间者，左心室重构的程度随病情的发展而改变，通过分析急性心肌梗塞后系列静息心肌显像，可对左心室重构程度的变化作出评价。结论左心室重构是评价急性心肌梗塞治疗效果和预后的重要依据；９９ｍＴｃ－ＭＩＢＩ心肌断层显像是评价急性心肌梗塞后左心室重构的有用技术。

Evaluation of ventricular remodeling following acute myocardial infarction with 99mTc-MIBI myocardial SPECT

Objective To evaluate left ventricular remodeling(LVRM) with 99mTc-MIBI myocardial SPECT in the patients with AMI.Methods Resting myocardial imaging with 99mTc-MIBI were preformed in 76 patients with AMI.Nongated myocardial SPECT was preformed in 42 patients.Thirtyfour patients were assessed with gated myocardial SPECT.Resting myocardial images were obtained about 12 hours,12 weeks and 13 months after suffering from AMI.Results Imaging chracteristics of LVRM were infarction expansion(IE):thinning (72/76),lengthening(58/76),regional enlargement(55/76) and regional distortion(51/76).Noninfarction myocardium:thickening(36/76) and lengthening(49/76);global distortion of shape(GDS)(35/76) and global ventricular dilatation(GVD)(42/76).The grade of remodeling was divided into 3 degrees.(25/76) was without GDS or/and GVD,(31/76) was with GDS or/and GVD,and (20/76) was between and .The changes of remodeling grade can be evaluated by analysing a series of myocardial SPECT.Conclusion LVRM is an important pred ictor of postmyocardial infarction prognosis and in following therapy.99mTc-MIBI myocardial SPECT is a useful technique for evaluating LVRM following AMI.