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。     

Discordance between dipyridamole technetium-99m-sestamibi myocardial perfusion single photon emission computed tomography and two-dimensional echocardiography in Kawasaki disease--a preliminary report

This study attempts to establish a noninvasive diagnostic method for early assessment of cardiac involvement in Kawasaki disease (KD), 36 children with KD were studied. The presence of abnormal coronary arteries (CA) with aneurysms was determined by experienced pediatric cardiologists using two-dimensional echocardiography (2D-Echo). Rest and dipyridamole-stress technetium-99m sestamibi (Tc-MIBI) single photon emission computed tomography (SPECT) was performed on the 36 children with KD for the assessment of myocardial perfusion and for comparison with 2D-Echo findings. The results showed that (1) 17/36 (47.2%) of the cases had no aneurysm and 19/36 (52.8%) had significant aneurysms; (2) 16/36 (44.4%) of the cases had normal myocardial perfusion and 20/36 (55.6%) had myocardial perfusion defects; (3) 9/36 (25.0%) cases showed both normal 2D-Echo and Tc-MIBI SPECT findings and 12/36 (33.3%) showed both abnormal 2D-Echo and Tc-MIBI SPECT findings; and (4) There was poor agreement between 2D-Echo and Tc-MIBI SPECT findings (-value = 0.161, p = 0.332). We concluded that the most of the KD children had aneurysms or abnormal myocardial perfusion. However, poor agreement exists between 2D-Echo and Tc-MIBI SPECT findings with aneurysms and abnormal myocardial perfusion in patients with KD.     

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.     

Feasibility of continuous venous infusion of SonoVue for qualitative assessment of reversible coronary perfusion defects in stress myocardial contrast echocardiography

OBJECTIVE: To study the feasibility of continuous intravenous SonoVue contrast echocardiography for qualitative assessment of reversible myocardial perfusion in dipyridamole stress tests. METHODS: Eleven patients (10 male and 1 female, mean age 66 years) with a history of chest pain and a clinical indication for stress sestamibi single photon emission computed tomography (SPECT) underwent concurrent SonoVue 99mTc myocardial contrast echocardiography (MCE). RESULTS: Of the total 176 segments obtained, 53 (30%) were regarded as indeterminate, 39 (22%) as discordant, and 84 (48%) as concordant between MCE and SPECT imaging. Two patients had abnormal SPECT results. The overall feasibility and specificity of MCE were 70 and 74%, respectively. The concordant (p = 0.59) and discordant (p = 0.55) segments were comparable with either MCE technique. However, continuous low-mechanical-index imaging produced fewer indeterminate segments (17 segments, 32%) than intermittent harmonic B-mode imaging (36 segments, 68%) (p = 0.04). Significantly more indeterminate segments were found in the left anterior descending artery territory. However, the overall concordance was similar (p = 0.5) in all three coronary artery territories. The concordance and discordance rates at different left ventricular levels (i.e., basal, mid, and apical) were similar (p = 0.50 and 0.08, respectively). CONCLUSION: Continuous-infusion SonoVue contrast echocardiography is feasible, with high specificity, for detecting myocardial perfusion defects as assessed by dipyridamole SPECT.     

Relationship between exercise-induced ST segmental depression and myocardial ischemia assessed by technetium-99m tetrofosmin SPECT imaging in patients with inferior Q wave myocardial infarction

Background: ST segment depression (STD) is a standard electrocardiographic sign of myocardial ischemia. Although STD may represent reciprocal changes in patients with previous myocardial infarction, studies of reciprocal changes during exercise testing are scarce. Methods: From December 1999 to December 2000, 160 patients (119 males, 41 females, mean age 54 ± 8 years), undergoing maximal or symptom-limited exercise treadmill test (Bruce-protocol), myocardial perfusion scintigraphy using technetium-99m tetrofosmin single photon emission computed tomography (SPECT) imaging, within 30 days of an uncomplicated inferior Q wave myocardial infarction. The location of STD at the electrocardiogram (ECG) was defined as anterior (V1-4), high lateral (I, aVL), and lateral (V5-6). Ischemia was defined as reversible perfusion abnormalities. Results: STD occurred in anterior leads in 29 patients (18.1%), in the lateral leads in 41 patients (25.6%), in the high lateral leads in 20 patients (12.5%). In 70 patients (43.8%) no significant STD occurred during the exercise test. ST segment elevation occurred in 28 patients (17.5%) in inferior leads. High lateral STD was associated with inferior ST elevation in 16 patients (80%), whereas only eight patients (19.5%) with lateral STD and nine patients (31%) with anterior STD were associated with inferior ST elevation. Ischemia was detected in 63 of 90 patients (70%) with and in 10 of 70 patients (14.3%) without STD (p < 0.0001). Patients with high lateral STD had a higher prevalence of fixed perfusion defects in the inferior wall (95 vs. 27.8%) and in posterolateral wall (75 vs. 18.9%) compared with other patients (p = 0.003 and 0.002, respectively). Ischemia was more prevalent in patients with lateral STD than without ( 87.8 vs. 14.3%, p < 0.0001). Conclusion: In patients with inferior Q wave, the presence of exercise-induced STD in lateral and anterior leads appears to be a sign of myocardial ischemia, and may require invasive evaluation; on the other hand, the presence of STD in high lateral leads should be recognized as a reciprocal change for ST elevation in the inferior leads, and may not be an indication for invasive evaluation.     

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。     

Discordance between dipyridamole stress technetium-99m tetrofosmin single photon emission computed tomography and coronary angiography in patients with Kawasaki disease

Kawasaki disease (KD) is an acute vasculitis syndrome of unknown etiology that mainly affects the coronary arteries. The purpose of this study was to assess the agreement between dipyridamole stress technetium-99m tetrofosmin (Tc-TF) myocardial perfusion single photon emission computed tomography (SPECT) and coronary angiography in these patients. Twenty-nine children with KD were included in this study. All of the 29 children also received dipyridamole stress Tc-TF myocardial perfusion SPECT within 1 month of their coronary angiographic studies. The results showed that (1) 89.7% of children had negative coronary angiographic findings without significant coronary stenoses, and 10.3% of children had positive coronary angiographic findings with significant coronary stenosis; (2) 44.8% of children had negative Tc-TF myocardial perfusion SPECT findings without abnormal myocardial perfusion, and 55.2% of children had positive Tc-TF myocardial perfusion SPECT findings with abnormal myocardial perfusion; (3) 44.8% of children had both normal coronary angiographic and Tc-TF myocardial perfusion SPECT findings, and 10.3% of children had both abnormal coronary angiographic and Tc-TF myocardial perfusion SPECT findings; and (4) There was no significant agreement between coronary angiographic and Tc-TF myocardial perfusion SPECT findings. We concluded that poor agreement exists between coronary angiographic and Tc-TF myocardial perfusion SPECT findings with coronary stenoses and abnormal myocardial perfusion in children with KD.     

Bone mineral density and single photon emission computed tomography changes after total knee arthroplasty: a 2-year follow-up study

Dual X-ray absorptionmetry (DXA) provides a highly reproducible method for quantitative analysis and monitoring periprosthetic bone mineral density (BMD) after total knee arthroplasty (TKA). Single photon emission computed tomography (SPECT) with bone avid radiopharmaceuticals reflects bone metabolic activity and circulation. We combined information from DXA and SPECT to assess the evaluation of the dynamic balance between BMD and bone turnover. Sixteen patients underwent serial DXA (Lunar Expert XL) and 99mTc-methylene diphosphonate SPECT measurements until 2 years after TKA. A rapid bone loss, up to 25.5%, was detected in femur during the first six postoperative months. However, tibial periprosthetic BMD remained close to baseline. There was a significant correlation between 12-month SPECT uptake and preceding BMD change in medial tibia (r = 0.5, P = 0.044). At 12 months, SPECT uptakes in the operated knee were notably higher compared with those of the control knee. SPECT uptakes showed statistically significant decreases from 12 months to 24 months, while SPECT uptake in the control knee remained stable. In tibia, the results are more complex; referring that increased bone remodelling is continuing below the tibial tray. Furthermore, femoral diaphyseal uptake remained elevated, while corresponding tibial uptake had levelled off at 2 years. Increased SPECT uptake during the first 2 years after uncomplicated TKA results most likely from normal postoperative bone remodelling. Levelling of SPECT uptake may indicate a new balance between bone loss and regain.     

Real-time perfusion adenosine stress echocardiography versus myocardial perfusion adenosine scintigraphy for the detection of myocardial ischaemia in patients with stable coronary artery disease

BACKGROUND: Real-time perfusion (RTP) contrast echocardiography using low mechanical index power modulation technique allows for simultaneous myocardial perfusion and wall motion analysis. RTP-adenosine stress echocardiography (ASE) could be an alternative to dobutamine-atropine stress echocardiography; more tolerable for the patients and possibly similarly accurate. We aimed to evaluate RTP-ASE for the detection of myocardial ischaemia, compared to 99mTc-sestamibi single-photon emission computed tomography (SPECT). METHODS: Patients with suspected coronary artery disease, admitted to SPECT evaluation, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using infusion of Sonovue (Bracco, Milano, Italy) before and during ASE. Two separate readers performed off-line analysis of myocardial perfusion and wall motion by RTP-ASE. A perfusion defect was the principal marker of ischaemia. Wall motion assessment was used to evaluate ischaemia in segments with perfusion artefacts. Each segment was attributed to one of the three main coronary vessel areas of interest: the left anterior descending (LAD); the left circumflex (LCx) and the right posterior descending (RPD). Normal SPECT at stress was judged normal at rest. RESULTS: In 33 patients, 99 coronary territories were analysed by SPECT and RTP-ASE. SPECT showed evidence of ischaemia in 9 of 33 patients. For the detection of ischaemia, the overall level of agreement between RTP-ASE and SPECT was 92% in all segments. The level of agreement was 88% in LAD, 97% in LCx and 91% in RPD segments. CONCLUSION: Real-time perfusion-adenosine stress echocardiography using power modulation could be an accurate and feasible tool for evaluation of ischaemia in patients with suspected coronary artery disease. The results from this study need confirmation by a study of a larger patient sample.     

Myocardial SPECT perfusion defect size compared to infarct size by delayed gadolinium-enhanced magnetic resonance imaging in patients with acute or chronic infarction

BACKGROUND: Single photon emission computed tomography (SPECT) perfusion imaging has been considered a reference method for non-invasive estimation of infarct size in man. Recently, delayed gadolinium-enhanced magnetic resonance imaging (DE-MRI) has evolved as an accurate tool to quantify infarct size. Therefore, the present study was designed to compare perfusion defect size by SPECT to hyperenhanced volume by DE-MRI. METHODS: DE-MRI was performed in 30 patients. Fourteen were patients with revascularized first-time acute infarctions, eight revascularized chronic infarctions, and eight clinically referred non-revascularized patients. SPECT was performed in the same patients and analysed by a commercial package. RESULTS: The hypoperfused volume by SPECT was larger than the hyperenhanced volume by DE-MRI by 8 +/- 8 ml (6% +/- 5 percentage points), 10 +/- 18 ml (6% +/- 11 percentage points), and 26 +/- 30 ml (12% +/- 10 percentage points) in the acute, chronic and clinical populations, respectively. Left ventricle wall volume was smaller by SPECT in all settings. CONCLUSION: The SPECT perfusion defect size was comparable with but generally slightly larger than the hyperenhanced volume by DE-MRI in both absolute and relative terms in patients with acute and chronic infarction. The results may be related to systematic differences between modalities but could also be influenced by biological phenomena such as wall thinning or hypoperfused but viable myocardium.     

Myocardial perfusion scintigraphy (SPECT) during adenosine stress can be performed safely early on after thrombolytic therapy in acute myocardial infarction

The objective of this study was to evaluate the safety of myocardial perfusion scintigraphy with Tc-99 m sestamibi during adenosine stress in patients with recent thrombolytically treated myocardial infarction. Eighty-four patients with thrombolytically treated myocardial infarction, 59 males and 25 females, aged 62·9 ± 8·4, were eligible for myocardial perfusion scintigraphy during adenosine provocation. Exclusion criteria for adenosine stress were hypotension, unstable angina pectoris, cardiac failure, pericarditis and atrioventricular block (AV block) II–III. Adenosine-stress and resting myocardial perfusion scintigraphy was performed 2–5 days after thrombolysis. Scintigraphy at rest was done 24 h after the stress study. Sixty patients (71%) experienced some kind of side-effects during adenosine infusion. The most frequent side-effects were dyspnoea in 43/84 patients (51%) and unspecific chest discomfort in 26/84 patients (31%). During infusion, ST depressions or elevations on ECG were seen in 9 patients (11%), 5 of whom experienced atypical chest discomfort. Five patients (6%) described typical angina but none of them showed electrographic signs of myocardial ischaemia during infusion. Six patients (7%) developed transient AV block I–II. Reversible scintigraphic perfusion defects were seen in 67 patients (79%). No serious complications, such as death, reinfarction or severe arrhythmias, occurred during adenosine infusion or during a 3-day clinical follow-up period. In conclusion, MIBI-SPECT during adenosine stress is a safe diagnostic method that can be performed in most patients early on after thrombolytically treated acute myocardial infarction. Side-effects are common but benign, and not different from those seen in patients with chronic coronary artery disease.     

单光子发射计算机断层照相机检测心肌挫伤后右心室功能变化

目的 :探讨心肌挫伤 (MC)后右心室功能的变化规律。方法 :采用单光子发射计算机断层照相机(SPECT)检测中度至重度 MC模型兔右心室功能。结果 :右心室射血分数 (EF)、1/ 3射血分数 (1/ 3 EF)、1/ 3射血率 (1/ 3 ER)在伤后 2 4小时〔分别为 0 .2 9± 0 .0 4、0 .2 7± 0 .12和 (53 7± 12 3 )× 10 - 2 / s〕仍然明显低于伤前〔分别为 0 .3 9± 0 .0 7、0 .3 7± 0 .10和 (788± 175)× 10 - 2 / s〕,P<0 .0 5;高峰充盈率 (PFR)在伤后 2小时下降明显〔(12 54± 188)× 10 - 2 / s比 (1874± 62 4 )× 10 - 2 / s,P<0 .0 5〕,然后开始上升 ,2 4小时为 (2 0 14± 787)× 10 - 2 / s,与伤前比较差异不显著 (P>0 .0 5) ;1/ 3充盈分数 (1/ 3 FF)在伤后 0 .5小时下降明显 (0 .4 4± 0 .16比 0 .2 6±0 .0 7,P<0 .0 5) ,而 1/ 3充盈率 (1/ 3 FR)上升明显〔(974± 4 0 2 )× 10 - 2 / s比 (12 4 7± 886)× 10 - 2 / s,P<0 .0 5〕,伤后 2小时又明显下降 ,8小时恢复〔分别为 0 .50± 0 .0 3和 (860± 168)× 10 - 2 / s〕,P均 >0 .0 5;PFR/ PER、1/ 3 FR与 1/ 3 ER比值在伤后 0 .5小时即开始下降 (分别为 0 .91± 0 .4 3和 0 .82± 0 .65,P<0 .0 5) ,PFR/ PER在伤后 2 4小时 (0 .98± 0 .50 )恢复至伤前水平 ,1/ 3     

心肌灌注显像在女性冠心病诊断中价值

目的评价心肌灌注显像对女性冠心病患者的诊断价值。方法 344例有胸痛、胸闷症状女性患者,行静息+药物负荷心肌灌注显像检测,并与冠状动脉造影结果进行对比分析。结果冠状动脉狭窄178例患者中心肌灌注显示异常者130例;冠状动脉造影无异常或不规则166例中心肌灌注显像异常50例,无异常116例;以冠状动脉造影结果为标准,心肌灌注显像对女性冠心病诊断的敏感度、特异度、阳性预测值、阴性预测值分别为73.0%,69.9%,72.2%,70.7%。结论心肌灌注显像对女性冠心病患者的诊断及是否进一步行冠状动脉造影的筛选有一定价值。     

常规超声心动图、心电图、动态心电图及核素心肌灌注断层显像对冠心病诊断的对比研究

目的对比分析常规超声心动图(UCG)、心电图(ECG)、动态心电图(Holter)及核素心肌灌注断层显像(SPECT)对冠心病的诊断价值。方法回顾性分析120例冠心病患者的UCG、ECG、Holter及SPECT检查结果,并与冠状动脉造影(CAG)检查结果作对照。结果 120例患者中,CAG检查98例患者为冠心病,UCG显示82例患者室壁节段运动异常,ECG显示68例患者ST-T段改变,Holter显示74患者例呈阳性,SPECT显示90例患者显像异常。UCG、ECG、Holter及SPECT诊断冠状病的敏感性和特异性分别为79.59%、60.20%、65.31%、83.67%和81.82%、59.09%、54.54%、63.64%。结论 UCG的敏感性略低于SPECT,但特异性明显高于其他方法,对冠心病的诊断有较高的准确性,值得临床的广泛应用。     

Cerebral hemodynamic patterns with technetium Tc 99m exametazime single photon emission computed tomography and transcranial Doppler sonography: a validation study using visual stimulation.

OBJECTIVE: To assess whether a correlation between perfusion changes to visual stimulus on the bilateral occipital areas and blood flow velocity changes to visual stimulus in both posterior cerebral arteries is present. METHODS: Nine right-handed healthy subjects (4 women and 5 men; mean +/- SD age, 58.0 +/- 5.6 years) were included in the study. Visual stimulation was performed in room light with the subject's eyes open and looking around versus eyes closed as the stimulus-off condition. The blood flow velocities were recorded using transcranial Doppler sonography, and the regional cerebral blood flow measurements were recorded with the use of technetium Tc 99m exametazime and a single photon emission computed tomographic gamma camera system. Individual reactivity was defined as a relative increase of blood flow velocity and perfusion, which were calculated as percentage changes of baseline values. RESULTS: Visual stimuli produced a marked increase of blood flow velocity in both posterior cerebral arteries (35.2 +/- 2.3 cm/s; P < .001) without a significant side-to-side difference in all subjects as well as a marked increase of perfusion on both occipital areas (24.9 +/- 4.8 cm/s; P < .01). Moreover, there was a positive correlation between blood flow velocity changes and perfusion changes on both sides (r = 0.833; P < .01). CONCLUSIONS: The use of bilateral simultaneous Doppler recordings by means of a flow velocity averaging algorithm to a specific stimulus allows quantitative assessment of blood flow responses, and simple visual stimuli can be applied for different disorders to assess the vasomotor regulation that may result in measurable abnormal cerebral flow regulation even when clinically stabilized.     

Quantification of myocardium at risk in myocardial perfusion SPECT by co-registration and fusion with delayed contrast-enhanced magnetic resonance imaging--an experimental ex vivo study

Background: Myocardial perfusion single‐photon emission computed tomography (MPS) can be used to assess myocardium at risk in occlusive coronary ischaemia. The aim was to develop a method to quantify myocardium at risk as perfusion defect size on ex vivo MPS using co‐registration and fusion with ex vivo magnetic resonance imaging (MRI). Methods: Pigs (n = 19) were injected 99mTc‐tetrofosmin prior to concluding 40 min of coronary artery occlusion, followed by reperfusion and MRI contrast injection. The excised heart was imaged with T1‐weighted MRI and MPS, and images were co‐registered using freely available software (Segment v1.8, http://segment.heiberg.se ). The left ventricle was semi‐automatically delineated in MRI and copied to MPS. The threshold for a MPS perfusion defect was defined as the mean counts in the MPS image at the MRI‐determined border between remote myocardium and air. The threshold was measured using count maxima set to the 100th–95th percentile of counts within the myocardium. The count maximum that gave the lowest threshold variability (SD) was considered the most robust. Results: A count maximum using the 100th percentile yielded a threshold of (mean ± SD) 55 ± 6·2%. This method showed the lowest SD compared to 99th–95th percentile count maxima (6·6–7·2%). Conclusions: We describe a method for objective quantification of myocardium at risk as perfusion defect size on MPS using knowledge of the anatomy of the myocardium from co‐registered MRI. This enables simultaneous quantification of myocardium at risk by MPS and infarct size by MRI for the evaluation of treatments for myocardial infarction.     

急性脑梗死后失语症与脑血流灌注的相关性探讨

Afteracutecerebrovasculardiseasebelongstoacquiredlanguagedysfunction，Itsincidenceisabout２１％～３３％．Theviewthatpathogenesisofaphasiaisrelatedtoinjuryofsomeregionofbrainhasbeenacceptednow．ObjectiveofthisstudywastoinvestigateclinicalmanifestsationsofaphasiaandtheircorrelationwithperfusionstateofcerebralbloodflowbySPECTbloodperfusionimagininginaphasiaafteracutecerebralinfarction．１Subjectandmethod１．１SubjectPatientswithacutecerebralinfarction，aged（６３．９５±８．４９）years，１２me…