定量门控201Tl心肌灌注显像测量左心室功能的临床研究

目的:探讨定量门控201Tl心肌灌注显像测量左心室功能的临床价值。方法:选择32例不同左心室功能受试者于3日内完成201Tl心肌灌注显像和门控心血池显像测量,比较两者测量的左心室功能参数的相关性;选择128例患冠心病风险概率极低者(小于10%)行201Tl心肌灌注显像检测,建立201Tl心肌灌注显像测量静息左心室射血分数的正常参考值;选择113例不同左心室功能受试者于7日内完成201Tl心肌灌注显像和二维超声心动描记术检测,评价两者测量左心室局部室壁运动的符合程度。结果:201Tl心肌灌注显像和门控心血池显像测量32例不同左心室功能受试者的3项静息左心室功能参数结果分别为:左心室射血分数犤(0.58±0.02)、(0.60±0.02)犦、舒张末期容积犤(67±5)mL、(79±6)mL犦、收缩末期容积犤(30±5)mL、(33±4)mL犦,两者比较的相关系数r分别为0.89、0.87、0.96,均呈显著的正相关(均为P<0.01)。左心室射血分数的正常参考值等于或超过0.43。201Tl心肌灌注显像评价室壁运动与二维超声心动描记术的结果中等符合(Kappa值=0.52,P<0.01)。结论:201Tl心肌灌注显像能准确地评价左心室功能,有较高的临床实用价值。     

门控心肌显像在测定左心室射血分数中的应用

目的:应用单光子发射计算机体层摄影(SPECT)技术同时测定不同采集条件下左心室射血分数(LVEF)值,并与超声LVEF值比较,研究其一致性和相关性。方法:选择172例受试者,利用SPECT共行门控显像技术,用99mTc-MIBI作为示踪剂,同时将心动周期设定8和16等份,在一次采集中得到两种条件的LVEF值,并与1周时间所得超声LVEF值作比较,研究门控心肌显像在LVEF测定中的影响因素,以及与常规超声法有无相关性。结果:统计分析显示,心动周期分成8和16等份所得的LVEF值大小是不同的,后者LVEF值较大,但两种方法所得结果存在相关关系。另一方面,SPECT所得的LVEF值均较超声心动图(UCG)所得值大,但与UCG所得结果具有很好一致性。结论:门控心肌显像在心肌活力判断时,利用共行显像技术可同时得到LVEF等心功能参数,其LVEF大小与超声结果有很大相关性,但其值存在显著差异,其正常参考范围尚需进一步研究。     

Comparison of myocardial gated single photon emission computerised tomography, planar radionuclide ventriculography and echocardiography in evaluating left ventricular ejection fraction, wall thickening and wall motion

Left ventricular ejection fraction (LVEF) and wall thickening are fundamental aspects of cardiac function. Recently, gated single photon emission computerised tomography (GSPECT) and anatomical M-mode echocardiography are new techniques, which have been introduced for the evaluation of left ventricular wall thickening and ejection fraction. These, however, have not been evaluated against established techniques, including equilibrium radionuclide ventriculography (ERNV), which remains the current gold standard for the evaluation of LVEF. We examined the concordance between LVEF, wall motion and wall thickening scores derived from GSPECT, echocardiography and ERNV, in a group of 16 patients with suspected ischaemic heart disease. Estimated ejection fraction correlated better between ERNV and gated SPECT (R2 = 0.93) than between echocardiography and either gated SPECT (R2 = 0.62) or ERNV (R2 = 0.71). There was poor correlation between gated SPECT and anatomical M-mode echocardiography in the assessment of wall thickening (83/150, 56%; kappa= 0.31, p < 0.05) and similar correlation (100/150, 66%; kappa = 0.29, p < 0.01) for wall motion analysis. In conclusion, estimations of ejection fraction by all the three studied modalities agreed to a degree sufficient for routine clinical practice. However, estimates of wall thickening from echocardiography cannot be used interchangeably with those derived from gated myocardial perfusion SPECT.     

实时心肌超声造影多指标联合应用对冠心病诊断的临床价值

目的 探讨实时心肌超声造影(RT-MCE)多指标联合应用对冠心病诊断的临床价值.方法 人选35例患者均行常规超声心动图检查和经静脉RT-MCE,并于RT-MCE检查后2-4 d行门控单光子发射计算机断层显像(gated-SPECT)检查,所有患者均于RT-MCE检查后1周内行冠状动脉造影(CAG)检查.以CAG为金标准分为冠心病组和非冠心病组.采用Qlab软件对造影图像微泡再充盈曲线进行定量分析,求出各节段的最大微泡数量(A)、造影剂充填速度(β)及其乘积A×β值;与CAG结果对比,采用受试者曲线寻求A值、β值及A×β值对冠心病的诊断截断点;对22例冠心病患者行Gensini评分,与A值、β值及A×β值行相关分析.②Gated-SPECT图像中所有节段采用4分计分方法,计算其诊断冠心病的敏感性和特异性.③分析RT-MCE多指标联合应用观察对冠心病的诊断价值.结果 ①A值、β值及A×β值在冠心病组与非冠心病组间差异有统计学意义(P<0.05);RT-MCE定量指标A值、β值及A×β值分别以4.58、0.64及2.73为截断点,其诊断冠心病的敏感性分别为86.O%、80.2%和88.9%,特异性分别为84.1%、64.6%和79.9%;A值、β值及A×β值与Gensini评分间的相关系数分别为-0.79、-0.51和-O.76.②Gated-SPECT诊断冠心病的敏感性和特异性分别为84.8%和82.7%.③A与β、A与A×β及β与A×β联合诊断的敏感性增加,分别为89.1%,90.4%及96.3%.结论 RT-MCE多指标联合应用优于gated-SPECT,可提高诊断冠心病的准确性和评价冠状动脉狭窄的严重程度.     

Alternative methods for the assessment of mechanical dyssynchrony using phase analysis of gated single photon emission computed tomography myocardial perfusion imaging

Measurement of left ventricular (LV) mechanical dyssynchrony from single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) allows optimization of cardiac resynchronization therapy in heart failure patients. We compared the discriminatory ability and reproducibility of a new software method, Corridor 4DM (4DM) to the established method, Emory Cardiac Toolbox (ECTb) in normals and heart failure patients. LV dyssynchrony was measured in 100 control (Group 1) and 100 patients with LVEF <35% (Group 2) using time to peak thickening with first harmonic, fourth harmonic, and volume curve methods with the 4DM software, and compared to ECTb. Of the 3 4DM methods, first harmonic had the best correlation with the ECTb (R?=?0.88, slope?=?1.00, P?相似文献   

Normal limits for left ventricular ejection fraction and volumes determined by gated single photon emission computed tomography--a comparison between two quantification methods

To compare gender-related normal limits for left ventricular (LV) ejection fraction (EF), end-diastolic and end-systolic volumes (EDV and ESV), obtained using two myocardial perfusion-gated single photon emission computed tomography (SPECT) quantification methods. A total of 185 patients were retrospectively selected from a consecutive series of patients examined for coronary artery disease (CAD) or for management of known CAD. Patients were included in the study group if they had normal or probably normal results with stress and rest perfusion imaging and if the combined interpretation of perfusion studies and gated rest studies showed no signs or suspicion of myocardial infarction. The gated SPECT studies were performed using a 2-day stress/gated rest Tc-99m sestamibi protocol. All patient studies were processed using CAFU and quantitative-gated SPECT (QGS), the two software packages for quantification of gated SPECT images. The lower normal limits for EF were higher for CAFU compared with QGS for both women (59% versus 53%) and men (54% versus 47%). The upper normal limits for EDV were also higher for CAFU compared with QGS for both women (133 versus 107 ml) and men (182 versus 161 ml). The differences between the software packages were small for ESV (women 44 versus 44 ml; men 69 versus 74 ml). Gender-specific normal limits need to be applied for LV EF and volumes determined by gated SPECT. Separate criteria for abnormal LV EF and EDV need to be used for women and men depending on the software package used.     

实时三维超声心动图定量评价急性前壁心肌梗死患者左室整体和节段心功能

目的探讨实时三维超声心动图（RT3DE）检测急性前壁心肌梗死患者整体和节段心功能的临床价值。方法运用RT3DE对20例急性前壁心肌梗死患者和41例正常人进行检查,脱机软件分析得出左室整体和17节段的容积-时间曲线,比较两组的整体和节段舒张末期容积（EDV、rEDV）、收缩末期容积（ESV、rESV）、射血分数（EF、rEF）及节段-整体射血分数（rgEF）。结果急性前壁心梗组整体EDV、ESV及梗死区域、邻近梗死区域的rEDV、rESV较对照组增大,整体EF值及其rEF、rgEF减小（P〈0.05）,远离梗死区域无差异（P〉0.05）。结论RT3DE能客观评价急性前壁心梗患者左室整体和节段心功能,是一项能运用于临床的准确、可行的新技术。     

斑点追踪显像、实时三维超声心动图与门控心肌灌注SPECT显像评价左心室收缩同步性的相关性研究

目的 探讨斑点追踪显像(speckle tracking imaging,STI)、实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)与门控心肌灌注SPECT显像(gated myocardial perfusion single-photon emission computed tomography,GMPS)评价冠心病患者左室收缩同步性的相关性.方法 13例冠心病患者进行STI及RT-3DE检查,获得左室12节段径向应变及圆周应变达峰时间标准差(Trs12-SD,Tcs12-SD),左室16节段纵向应变达峰时间标准差(Tls16-SD),左室16节段和12节段达最小容积时间标准差(Tmsv16-SD,Tmsv12-SD).测量结果与GMPS评价左室收缩同步性参数进行比较.结果 STI参数Trs12-SD与GMPS参数相位标准差、相位宽度正相关(分别为r=0.800,P＜0.05;r=0.607,P＜0.05);RT-3DE参数Tmsv16-SD与GMPS参数相位标准差、相位宽度相关性更好(分别为r=0.847,P=0.001;r=0.890,P＜0.001).结论 RT-3DE参数较STI参数与GMPS参数的相关性更好,提示RT-3DE参数有望成为评价左心室收缩同步性的理想指标.     

超声二维斑点追踪成像技术定量评价正常大鼠左心室整体和局部心肌功能

目的 探讨二维超声斑点追踪成像技术(2D-STI)评价正常大鼠左心室整体和局部心肌功能的应用价值.方法 20只健康成年雄性Wistar大鼠分别于基础状态和低剂量多巴酚丁胺负荷时接受超声心动图检查,记录左心室乳头肌短轴高帧频图像.测量节段心肌的收缩期峰值径向应变(PRS)、环向应变(PCS)及左心室整体峰值径向应变(G_(PRS))和环向应变(G_(PCS)),并采用解剖M型测量左心室舒张末期内径和收缩末期内径(LVIDd、LVIDs)、短轴缩短率(FS)、射血分数(EF).观察负荷实验时各项指标的动态变化,分别分析EF和左心室整体二维应变值(G_(PRS)、G_(PCS))的相关性.结果 基础状态时大鼠左心室乳头肌短轴各节段PRS值差异无统计学意义(P>0.05),各节段PCS值存在不均一性,前间隔和前壁的PCS测值最大,下壁的PCS测值最小(P<0.05).多巴酚丁胺负荷时,左心室乳头肌短轴G_(PRS)、G_(PCS)、节段心肌的PRS、PCS值和常规超声心动图的FS和EF随多巴酚丁胺剂量增加而增大(P<0.05);多巴酚丁胺剂量为10.0 μg/(kg·min)时上述指标与剂量为5.0 μg/(kg·min)时差异均无统计学意义(P>0.05).基础和负荷状态时EF和左心室整体二维应变值(G_(PRS)、G_(PCS))均有良好的相关性.结论 2D-STI技术可无创、简便地评价正常大鼠基础状态和低剂量多巴酚丁胺负荷时左心室整体和局部心肌形变,具有良好的重复性.     

Left ventricular function at the time of left x-ray contrast ventriculography

To study left ventricular function during radiocontrast ventriculography, 23 patients with a rejected diagnosis of coronary disease were examined. All the patients underwent coronarography, direct ventriculography with the aid of a special catheter with a microtip pressure microtransducer and intravenous biventriculography with injection of a radiocontrast agent to the right atrium with simultaneous monitoring of the pressure in the left ventricle. All the ventriculograms were subjected to a multiframe analysis with the aid of computer. During ventriculography, direct injection of a radiocontrast agent significantly influenced left ventricular function in all the phases of a cardiac cycle. The pressure in the left ventricle and energy parameters of the cycle of heart contraction increased. In the diastole, the elasticity of chamber walls reduced. The end diastolic volume increased, which led to the overstatement of the design parameters of cardiac output (by about 10 to 15%). All that resulted in the distortion of the data and lowered the scientific value of the information derived. Therefore, the search for alternative angiographic methods of estimating left ventricular function is badly needed.     

短暂性全面遗忘症3例局部脑血流显像观察2年随访

目的探讨短暂性全面遗忘症(TGA)的发生与局部脑血流(rCBF)改变的关系。方法对3例临床诊断为TGA患者行单光子发射计算机体层摄影(SPECT)rCBF显像检查。结果2例患者SPECT显像示左海马区血流灌注减低,1例示双侧额叶血流灌注减少。3例患者随访24个月,均无再次遗忘发作,复查SPECT显像示血流灌注正常。结论TGA的发生可能与额叶及海马局部血流灌注减低有关。     

Exercise echocardiography and single photon emission computed tomography in patients with left anterior descending coronary artery stenosis

To compare the diagnostic value of exercise echocardiography and perfusion single photon emission computed tomography (SPECT) in the detection of the presence and the severity of coronary artery disease, we studied 21 patients with isolated stenosis of different degree of the left anterior descending artery. Both echocardiography and SPECT were performed in conjunction with the same symptom-limited bicycle exercise test. Positivity of the test was based on the presence of exercise-induced wall motion abnormalities and transient perfusion defects, respectively. For both tests, an ‘ischemic’ score was derived, as index of extent and severity of myocardial ischemia. Coronary arteriography was evaluated by caliper. The agreement between exercise echocardiography and SPECT for the presence of coronary artery disease was 90%; the discordance was due to two patients with positive echocardiography and negative SPECT. A good correlation between ischemic wall motion and perfusion score indices was found (r=0.78, p<0.0001. Moreover, the percent diameter stenosis was well correlated with both ischemic indices (r= 0.75, p<0.0001; r=67, p<0.001, respectively). In patients with a positive test, the mean value of ischemic wall motion score index was higher in patients with a diameter stenosis ≥ 70% than in patients with a diameter stenosis <70% (0.59 ± 0.19 vs 0.29 ± 0.12, p < 0.01); a similar trend was found for ischemic perfusion score index (0.51 ± 0.35 vs 0.27± 0.12, ns). The results of this study indicate that in patients with single vessel disease of left anterior descending artery exercise echocardiography and SPECT give the same information on the presence, the extent and the severity of myocardial ischemia.     

Comparison of strain doppler echocardiography and radiologic left ventriculography for quantitative assessment of regional myocardial function

Objective We aimed to study the comparison of strain and strain rate parameters with conventional left ventriculography derived regional function. Method Forty patients were included in the study. The study group was selected from patients who had undergone left ventriculography and coronary angiography for clinical indications. Regional myocardial function was assessed using the centerline method via ACOM PC Quantcor LVA measurement system. Patients were also evaluated with echocardiography. Strain and strain rate Doppler echocardiographic measurements were compared with conventional left ventriculography at anterobasal, anterolateral, inferior and posterobasal segments. Results Radiological left ventricular radial shortening was found to correlate with longitudinal strain shortening in all ventriculographic segments examined (anterobasal, r = 0.771, P < 0.0001; anterolateral, r = 0.790, P < 0.0001; posterobasal, r = 0.861, P < 0.0001; inferior, r = 0.815, P < 0.0001). Correlation was persistent both in patients with or without coronary artery disease. The sensitivity of a peak systolic longitudinal strain >12.5% for prediction of patients with radial shortening ≥20% was 75%, with a specificity of 100%. However, no relationship could be demonstrated between radiological left ventricular radial shortening and strain rate measurements. Conclusions In our study it was shown that regional wall motion can be measured quantitatively via strain Doppler echocardiography with the left ventriculography as reference.     

健康人左心室节段与整体功能关系的初步研究

目的探讨健康人左心室节段与整体功能的关系。方法采用实时三维超声心动图测量31例健康志愿者左心室节段与整体容积,从而定量左心室节段与整体功能的关系。结果30例健康志愿者获得了满意的左心室整体及节段容积-时间曲线;各节段室壁对整体收缩及舒张功能的贡献从基底段到心尖段逐渐减低;从心尖帽、前壁、室间隔、侧壁到下壁,室壁对整体收缩功能的作用逐渐增强;从心尖帽、前壁、室间隔、下壁到侧壁,室壁对整体舒张功能的作用逐渐增强。结论健康人左心室节段对整体功能的作用不一致,存在异质性。     

Measurement of myocardial blood flow velocity reserve with myocardial contrast echocardiography in patients with suspected coronary artery disease: comparison with quantitative gated Technetium 99m sestamibi single photon emission computed tomography.

BACKGROUND: The ability of high and low mechanical index (MI) imaging methods during myocardial contrast echocardiography (MCE) to assess the physiologic significance of coronary stenoses were compared with technetium 99m sestamibi single photon emission computed tomography (SPECT) in patients. METHODS: Intermittent ultraharmonic imaging (high MI) and power modulation angio (low MI) were performed during continuous infusions of the echo-enhancing contrast agent, Optison, at rest and after dipyridamole stress in 39 patients. Technetium 99m sestamibi SPECT was performed simultaneously. Images from the 3 apical windows were divided into 6 walls. Myocardial blood flow (MBF) velocity and MBF velocity reserve were quantified from pulsing interval versus acoustic intensity MCE curves in each wall using postprocessed images. RESULTS: Approximately 25% of the myocardial walls could not be analyzed from MCE because of artifacts. MBF velocity and MBF derived from both MCE methods increased significantly after dipyridamole in healthy patients (n = 143 and 129 walls for high and low MI, respectively), compared with those with either reversible (n = 11 and 10 walls for high and low MI, respectively) or fixed defects (n = 18 and 14 walls for high and low MI, respectively) on SPECT. Consequently, MBF velocity and MBF reserve were significantly greater for patients with normal perfusion. Receiver operator characteristic curves obtained for MBF velocity reserve provided a sensitivity and specificity of 82% and 87%, respectively, for high MI; versus 64% and 96%, respectively, for low MI imaging after uninterpretable images were excluded from analysis. CONCLUSIONS: Both high and low MI MCE imaging techniques can be used to determine the presence of perfusion defects as identified by technetium 99m sestamibi SPECT. Low MI imaging methods have a number of drawbacks that limit its sensitivity compared with high MI techniques.     

实时三维超声心动图评价急性心肌梗死患者左心室整体和局部心功能

目的 探讨实时三维超声心动图(RT-3DE)评价左室下壁、正后壁、侧壁急性心肌梗死患者整体和节段心功能的临床价值.方法 应用RT-3DE对23例下壁、正后壁、侧壁急性心肌梗死患者和41例正常人进行检查,软件分析得出左室整体和17节段的容积-时间曲线,比较正常组与心肌梗死组的整体和各节段舒张末期容积(EDV、rEDV)、收缩末期容积(ESV、rESV)、射血分数(EF、rEF)及节段-整体射血分数(rgEF)的差异.结果 与正常组比较,下壁、正后壁、侧壁急性心肌梗死组的整体心功能及梗死节段的心功能变化差异有统计学意义(P＜0.05),邻近梗死节段中部分节段的心功能变化差异有统计学意义(P＜0.05),远离梗死节段的大部分节段的心功能变化差异无统计学意义(P＞0.05).结论 RT-3DE可以定量评价急性心肌梗死患者整体和节段心功能.     

Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography

Objective The aim of this study was to compare the diagnostic accuracy of myocardial perfusion imaging (MPI) by positron emission tomography (PET) with the diagnostic accuracy of MPI by single photon emission computed tomography (SPECT) in two comparable patient cohorts, using coronary angiography (CA) as the standard of reference. Methods A “SPECT-group” of 80 patients (15 female, 65 male; mean age 60 ± 9 years) and a “PET-group” of 70 patients (14 female, 56 male; mean age 57 ± 10 years) underwent a one day stress/rest examination either with attenuation-corrected ¹³N-ammonia PET or attenuation-corrected ²⁰¹TlCl SPECT or ^99mTc-hexakis-methoxy-isobutyl-isonitril (MIBI) SPECT. PET and SPECT results were semiquantitatively graded using a 6-segment heart model. All patients underwent CA, and stenoses were graded as a diameter reduction ≥50%. Results Coronary findings between both groups did not significantly differ at CA. For the SPECT-group overall sensitivity and specificity for localisation of stenoses was 77% and 84%. Respective values for the PET-group were 97% and 84%. The specificity of MPI by SPECT in the detection of ischemia was 74% and 91% for MPI by PET. The diagnostic accuracy of MPI improves when the individual coronary dominance and previous coronary revascularisations are taken into account. Conclusion MPI by ¹³N-ammonia PET is more sensitive in the detection and localisation of coronary stenoses, and more specific in the detection of ischemia than MPI by ²⁰¹TlCl/^99mMIBI SPECT.     

多巴酚丁胺超声心动图负荷试验与放射性核素心肌灌注显像对心肌存活性的对比研究

目的 评价小剂量多巴酚丁胺超声心动图负荷试验(DSE)和放射性核素心肌灌注显像(SPECT)预测心肌存活性的价值。方法 以15例成功行经皮冠脉介入治疗(PCI)患者术后6个月室壁运动改善为检验标准，进行小剂量多巴酚丁胺超声心动图负荷试验及SPECT检查，比较两者检测心肌存活性的准确性。结果 小剂量多巴酚丁胺超声心动图负荷试验峰剂量期与低剂量期在预测心叽存活敏感性、阴性预测差异具有显著性意义；与DSE相比，SPECT具有较高的敏感性但其特异性较低。结论 DSE与SPECT检测心肌存活性的准确性各有优点，但DSE更具实用性。     

SPECT仪器质量控制和质量保证的初步探讨

单光子发射型计算机断层显像仪(SPECT)是核医学影像诊断中常规显像仪器,SPECT仪器质量控制是可靠影像结果的重要保证[1-3].本文对我科SPECT 2003年1月～2007年12月的室内质量控制和相关质量保证加以分析,探讨SPECT仪器质量控制与质量保证的重要性.