门控心肌灌注显像诊断冠心病的临床价值

目的:探讨腺苷负荷99mTc-MIBI门控心肌灌注显像(G-MPI)后室壁运动和增厚率异常对冠心病的诊断价值。方法:对91例确诊或临床疑诊为冠心病患者行静息-腺苷负荷99mTc-MIBI G-MPI和非门控心肌灌注显像(MPI),两周内行冠状动脉造影(CAG),对其结果进行对比分析。结果:MPI诊断冠心病的灵敏度为85.3%,特异性为73.9%,G-MPI诊断冠心病灵敏度为92.6%,特异性为87.0%,结合腺苷负荷后局部室壁运动和增厚率评分可提高G-MPI诊断冠心病的灵敏度和特异性。结论:静息-腺苷负荷99mTc-MIBI G-MPI对冠心病的诊断有较高的灵敏度和特异性。     

门控心肌灌注显像在冠状动脉粥样硬化性心脏病诊断中的应用价值

目的探讨门控心肌灌注显像(GMPI)对冠状动脉粥样硬化性心脏病(CAD)的诊断价值。方法对房山区第一医院2014年1月至2015年12月临床确诊或疑诊CAD且2周内均行运动负荷+静息GMPI及冠状动脉造影(CAG)的84例患者进行回顾性分析。观察GMPI对CAD的诊断效能,比较GMPI对不同支数冠状动脉病变的敏感度,比较GMPI对不同狭窄程度冠状动脉病变的敏感度。结果①GMPI诊断CAD的敏感度为97. 4%,特异度为100%,准确性为97. 6%。②GMPI检测单支、双支和3支病变的敏感度分别为76. 67%、94. 34%、87. 50%。③CAG显示,74例患者共134支血管异常,其中102支血管轻度狭窄,25支血管中度狭窄,11支血管重度狭窄。GMPI检测上述3种不同程度狭窄血管的敏感度分别为65. 69%、96. 00%、90. 91%。结论 GMPI对CAD诊断具有较高的灵敏度和特异度,在CAD的诊断中具有重要价值。     

门控心肌断层显像定量分析心肌灌注和心室功能

目的：评价一次显像同时获得心肌灌注和心肌壁收缩功能，室腔射血功能的改变对冠心病中的临床意义。方法：（１）用自动门控定量分析软件，获得舒张末期容积（ＥＤＶ），收缩末期容积（ＥＳＶ）和ＬＶＥＦ对正常，心梗，心肌缺血三组做了统计和分析，（２）将舒张末期（ＥＤ）灌注，局部ＥＦ，局部壁运动，和壁增厚度４个靶心图各划分为９个区段计算心梗组各项异常节段并作分析，结果：（１）心梗组和正常组心室功能参数差别有显著性     

SPECT心肌灌注显像在诊断冠心病方面的应用

我院自1992年10月引进SPECT以来已进行200余例心肌灌注显像,现将其中临床诊断为冠心病的129例病人作一总结如下。 1 资料和方法 1.1 临床资料:正常人10例,男女各5人,年龄30～65岁,平均46.6岁,既往无冠心病史,ECG、超声心动图检查均为正常;129例病人,由心内科医师最后诊断为冠心病(包括心绞痛116例和心肌梗塞13例),其中男107人,女22人,年龄20～77岁,平均为55.1岁,其中超声心动图检查79人,心电图检查114人。 1.2 检查方法:先对由北京阜外医院提供的心肌模型(前壁及间壁各有一矩形模拟梗塞灶的有机玻璃块)进行模拟断层检查,在心肌腔内注入~(99m)TcO7.4MBq(2mci),置于断层床上模拟人体仰卧位时心脏位置,用SOPHA MEDICAL DS7型SPECT     

核素门控心肌灌注断层显像临床应用进展

核素心脏检查主要是两方面的内容,一是心肌灌注显像反映心肌血流灌注情况,二是心室显像检查心脏功能。为了能缩短患者确诊时间,减少多次显像带来的辐射,提高价格效益比,广大核心脏病工作者渴望通过一次核素心脏检查来获取尽可能多的信息,为此自８０年代中期以来作了...     

静息门控断层心肌灌注显像在冠心病治疗抉择中的价值王 平,王远智,叶世琴,等

目的探讨静息门控断层心肌灌注显像在冠心病治疗抉择中的价值。方法54例心脏疾病患者,其中冠心病32例,动脉粥样硬化13例,其他心脏疾病9例（心肌桥3例、心肌病5例、x综合征1例）,均行静息门控断层心肌灌注显像检查,并与冠状动脉造影结果进行对比分析。结果静息门控断层心膪灌注显像阳性率分别为：冠心病组94％（30／32）、动脉粥样硬化组69％（9／13）、其他心脏疾病组100％（9／9）。结论静息门控断层心肌灌注显像可灵敏反映心肌血供状况及预估心肌活力,在心血管疾病,尤其是冠心病（CAD）的诊断、危险分层、疗效评估、预后判断和治疗方案的制定中有着非常重要的价值。应作为冠脉造影及支架安放或搭桥术前基础评估手段,避免盲目’过度治疗。     

门控心肌显像测定左心室射血分数——一种测量方法的应用评价

目的 评价门控心肌灌注显像测量ET值的方法。方法 采用门控心肌灌注显像测量EF值的方法进行模型研究及对12例病人检查测量EF值并与平均法心血池显像测量值进行对比。结果 对模型的测量发采用butterworth滤波函数陡度因子为5,截止频率为0．5时,软件测定值最接近真实值。软件测定值与模拟体积真实值相关性很好（r=0.98)。对病人的研究显示,采用该方法测量左室EF值与心血池测量值有较高的相关性（r=0.93),且重复性良好（CV（5％）。结论 采用门控心肌灌注显像可准确对左心室EF值进行测定,提高了心肌灌注断层显像的临床检查价值。     

门控心肌灌注显像评价高海拔地区骨髓干细胞移植治疗心肌梗死的疗效

目的 用99Tcm-MIBI门控心肌灌注显像评价经冠状动脉内自体骨髓干细胞移植后高海拔地区急性心肌梗死后心功能及心肌灌注的变化.方法 33例前壁心肌梗死患者随机分为两组.18例(对照组)仅行经皮冠状动脉腔内成形术,余14例(移植组)在此基础上行干细胞移植术.均于术前及术后6和12个月行静息心肌灌注显像.结果 干细胞移植术后6个月,移植组患者的左心室射血分数(LVEF)较术前提高8%～9%,而对照组患者术后6个月随访LVEF改善程度均低于移植组.结论 骨髓干细胞移植可明显改善心肌收缩功能和心肌灌注.     

门控心肌灌注断层显像与冠状动脉造影对急性心肌梗死的诊断价值比较

目的比较冠状动脉造影与门控心肌灌注显像诊断急性心肌梗死的临床价值。方法20例急性心肌梗死患者在2周内分别行门控心肌灌注断层显像、冠状动脉造影及其他影像检查,分别将冠状动脉造影结果、门控心肌灌注图像及室壁增厚率分级（各4级）进行比较。结果门控心肌灌注图像、左室室壁增厚率均与冠状动脉造影分级结果间有较好的相关性,左室室壁增厚率与心肌灌注图像分级结果间有较好的相关性。结论门控心肌灌注显像可提供心肌灌注图像、左室功能及左室运动参数,可作为冠状动脉造影前的可靠筛查手段。     

门控心肌断层显像定量分析心肌灌注和心室功能

目的：评价一次显像同时获得心肌灌注和心肌壁收缩功能、室腔射血功能的改变在冠心病中的临床意义。方法：①用自动门控定量分析软件，获得舒张末期容积（ＥＤＶ）、收缩末期容积（ＥＳＶ）和ＬＶＥＦ对正常、心梗、心肌缺血三组做了统计和分析。②将舒张末期（ＥＤ）灌注、局部ＥＦ、局部壁运动、和壁增厚度４个靶心图各划分为９个区段计算心梗组各项异常节段并作分析。结果：①心梗组和正常组心室功能参数差别有显著性，心肌缺血组与正常组差别无显著性。②心梗组灌注异常节段大多伴有心肌壁功能受损（６７／８３），但存在更多心肌壁功能受损节段在灌注正常区（１８个）；灌注异常阶段中尚有１０个节段壁功能正常。结论：门控心肌断层显像整体心室功能参数在心梗的评价中有优越性对心肌缺血的诊断价值不大；心梗中存在有不少的局部灌注与心肌壁功能异常节段的不匹配，对心肌存活的评价有帮助     

Impact of SPECT myocardial perfusion imaging on cardiac care

Single photon emission computed tomography myocardial perfusion imaging is a powerful modality for the assessment of coronary artery disease. It is useful in the diagnosis of CAD, prognostication of CAD and the determination of viability. It acts as guide for therapy and has the ability to assess effectiveness of therapy. The use of SPECT myocardial perfusion imaging has also been shown to be cost–effective compared to other modalities in cardiology.     

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。     

Extra cardiac activity detected on myocardial perfusion scintigraphy after intra-arterial injection of 99mTc-MIBI

Purpose: We present an unusual case of extra cardiac activity of ^99mTc‐MIBI in the left part of thorax and left upper extremity in a patient admitted for myocardial perfusion scintigraphy. Methods: A standard 2‐day protocol of ^99mTc‐MIBI perfusion scintigraphies starting day 1 with stress (dipyridamol) imaging and followed by rest imaging day 2 was performed. Results: On day 2, when rest perfusion scintigraphy was carried out, extra cardiac activity was present in the left part of thorax and in the left upper extremity resulting in reduced accumulation of ^99mTc‐MIBI in cardiac tissue, prolongation of the study and interference of the extra cardiac activity with the cardiac image reconstructions. Whole‐body scintigraphy disclosed an arterial flow distribution of activity to skeletal muscles in left shoulder and upper limb. Conclusion: Accidentally injected radiotracer retrogradely into the arterial system resulted in an unusual extra cardiac activity interfering with later image processing.     

Improved quantification in pinhole gated myocardial perfusion SPECT using micro‐CT and ultrasound information

Absolute quantification using single photon emission computed tomography (SPECT) was demonstrated in vitro and in large immobile organs in vivo. To determine the feasibility of in vivo quantification of myocardial perfusion in pinhole gated SPECT, we added an ultrasound derived partial volume correction factor to attenuation and scatter corrections, in combination with gated acquisitions. In nine male Wistar rats, cardiac ultrasound was performed prior to SPECT/CT scans to determine the myocardial wall thickness. SPECT/CT scans were then performed 30 min after injection of ^99mTc Tetrofosmin. Animals were killed and six midventricular segments of the left ventricle were excised and counted in a γ‐well counter. Using AMIDE, regional myocardial activity was measured after combined scatter correction (SC) and attenuation correction (AC). These image derived activities were compared with the ex vivo counted activity. To correct for the partial volume effect, a recovery coefficient was determined from a phantom study, to determine the thickness specific partial volume effect. Combined AC and SC led to a significant underestimation of activity compared with ex vivo data (root mean squared error = 0.145 mCi g^?1). The recovery coefficient calculated from the phantom study showed a linear relationship with object size from 1 to 6 mm, positioned in the vicinity of the center of the field of view (R² = 0.98). Correction of nongated SPECT images with a recovery coefficient derived from the diastolic phase results in a global overestimation with root mean squared error = 0.04 mCi g^?1. Nongated SPECT images corrected with a recovery coefficient with a weighted average ratio diastolic and systolic phase led to an improved root mean squared error of 0.03 mCi g^?1. Combining attenuation correction with scatter correction and a gated partial volume correction yields the best correlation with ex vivo counting (root mean squared error = 0.021 mCi g^?1 (systolic) and 0.025 mCi g^?1 (diastolic). This study demonstrates a method for improved segmental myocardial perfusion quantification in pinhole gated SPECT, using combined attenuation‐, scatter‐ and ultrasound‐derived partial volume effect corrections. Copyright © 2012 John Wiley & Sons, Ltd.     

Review: comparison of PET rubidium‐82 with conventional SPECT myocardial perfusion imaging

Nuclear cardiology has for many years been focused on gamma camera technology. With ever improving cameras and software applications, this modality has developed into an important assessment tool for ischaemic heart disease. However, the development of new perfusion tracers has been scarce. While cardiac positron emission tomography (PET) so far largely has been limited to centres with on‐site cyclotron, recent developments with generator produced perfusion tracers such as rubidium‐82, as well as an increasing number of PET scanners installed, may enable a larger patient flow that may supersede that of gamma camera myocardial perfusion imaging.     

Pulsed tissue Doppler imaging for the detection of myocardial ischaemia, a comparison with myocardial perfusion SPECT

In order to compare the diagnostic ability of pulsed tissue Doppler and myocardial perfusion Single Photon Emission Computed Tomography (SPECT) in patients with a history of unstable coronary artery disease, CAD, 26 patients, 22 men and four women, age 47-76 years, were investigated in a prospective study, 5-10 day after an episode of unstable angina. Tissue Doppler and two-dimensional echocardiography were performed during dobutamine stress testing and myocardial scintigraphy after bicycle exercise and at rest. Patients with a normal SPECT had higher peak systolic velocity during dobutamine infusion, 18.9 +/- 4.1 cm s(-1), than patients with ischaemia, 12.2 +/- 3.8 cm s(-1) (P<0.001) or scar, 8.8 +/- 3.0 cm s(-1) (P<0.01). In a territorial analysis the difference in peak systolic velocity between areas with a normal and abnormal SPECT was less apparent. Failure to achieve >/=13 cm s(-1) in mean-peak systolic velocity was the most accurate criterion for detection of significant CAD on SPECT. We conclude that pulsed tissue Doppler can be used for objective quantification of left ventricular wall motion during dobutamine stress testing and for identification of patients with CAD on SPECT but not for identification of regional ischaemia.     

门控心肌显像与心血池显像测量左室射血分数的比较

目的评价ECToolbox软件测量门控心肌显像左室射血分数(LVEF)的临床价值.方法 31例患者接受静息态门控心肌显像,用ECToolbox软件测量LVEF,并与一周内门控心血池显像测量的结果比较.结果全部患者用ECToolbox软件测量值与心血池显像测量值的相关性为r=0.699(P<0.001);二者无统计学差别(P＞0.05).EDV<70 ml组患者ECToolbox软件测量值与心血池显像测量值无相关性;前者高于后者(P<0.05).EDV≥70 ml组ECToolbox软件测量值与心血池显像测量值呈强相关(r=0.834,P<0.001);二者无统计学差别(P＞0.05).ECToolbox软件测量值对左室收缩功能是否正常的判断与门控心血池显像无差别(P＞0.05).结论用门控心肌显像ECToolbox软件测量LVEF与门控心血池显像比较相关性好且结果准确,但EDV<70 ml时会高估测量值.     

核素心肌灌注显像诊断无症状性心肌缺血价值

目的探讨核素心肌灌注显像诊断无症状性心肌缺血的临床应用价值。方法动态心电图或其他心电检测技术检测无症状性心肌梗死患者22例,均行核素心肌灌注显像与冠状动脉造影检查,并以冠状动脉造影结果为金标准,计算核素心肌灌注显像结果预测值。结果 22例患者中8例核素心肌灌注显像表现为不可逆性心肌缺血,14例表现为混合性心肌缺血,共检测出40个节段病变心肌。冠状动脉造影检出阳性血管45支(血管狭窄程度≥50%),其中28支狭窄程度>90%,15支狭窄程度>70%~90%,2支狭窄程度≤70%。核素心肌灌注显像阳性结果预测值为88.9%(40/45)。结论核素心肌灌注显像有助于无症状性心肌缺血诊断,并可用于评价心肌损害严重程度。     

Single Tc99m Sestamibi injection,double acquisition gated SPECT after stress and during low-dose dobutamine infusion: a new suggested protocol for evaluation of myocardial perfusion

Background The ability of low dose dobutamine (LDD) has been established in exploiting the reserved contractility of ischemic myocardium. This study was designed to assess the value of a new protocol, with an additional stress imaging during LDD infusion instead of the rest images, for evaluation of coronary artery disease (CAD) and perfusion reversibility. Methods A total of 51 patients (42 men, 9 women; 57.2 ± 11.3 years) were included in the study and underwent three sequential steps of imaging; the first step-stress gated SPECT with Tc-99m sestamibi, immediately followed by the second step-gated SPECT during constant infusion of 7.5 μg/kg/min dobutamine and finally the third step-rest phase scan following trinitroglycerine administration in the next day. The findings were interpreted using the images in three sets of display; first vs. second step-single injection-double acquisition gated SPECT before and during LDD (SIDAGS-LDD), first vs. third step-standard stress/rest protocol, and only first step-gated stress-only SPECT. In all cases, the Visual perfusion index of each protocols were calculated by summating the premeditated 5-point scale (5: normal, 4: completely reversible, 3: partially reversible, 2: nontransmural fixed and 1: transmural fixed defects) of 17 standard myocardial segments. The accuracy as well as the correlation and agreement of protocols for detecting perfusion abnormality and corresponding reversibility were statistically analyzed. Results Calculated sensitivity, specificity, positive predictive value, negative predictive value and accuracy regarding the presence of CAD in both SIDAGS-LDD and standard protocols were 90.9% (40/44), 71.4% (5/7), 95.2% (40/42), 55.6% (5/9) and 88.2% (45/51), respectively. The extent and localization of perfusion abnormality with the new protocol were correlated well with standard method. The estimation of reversibility, however, was considerably improved by SIDAGS-LDD, especially in those with history of previous myocardial infarction (MI). Conclusion Our proposed protocol demonstrates good correlation and agreement with standard method and even is superior in some cases especially for estimation of viability after MI. Regarding no need for the rest phase radiotracer injection and imaging, this protocol can be more convenient (except the need for close monitoring of the patient during LDD infusion), less time-consuming, less expensive and moreover with less radiation burden to the patients and personnel.     

Stress radionuclide myocardial perfusion imaging detects more residual ischemia than stress echocardiography following acute myocardial infarction

OBJECTIVES: This investigation sought to compare the abilities of stress radionuclide myocardial perfusion imaging and stress echocardiography to detect residual ischemia in patients following acute myocardial infarction (MI). BACKGROUND: Stress radionuclide myocardial perfusion imaging and stress echocardiography are both commonly used to assess patients (patients.) in the immediate post MI period. However, the relative value of these techniques in identifying post MI ischemia remains unclear. METHODS: Eighteen patients. underwent both dipyridamole radionuclide perfusion imaging and dobutamine stress echocardiography on the same day or on consecutive days, 3-7 days following uncomplicated acute MI. Pts. who had an acute percutaneous intervention were excluded. Images were reviewed with clinical information available, but blinded to the opposing modality, for perfusion defects, wall motion abnormalities (WMA), and evidence of ischemia (reversible defect(s) on perfusion imaging, worsening WMA on stress echocardiography). Of the 18 patients, 11 subsequently underwent cardiac catheterization. RESULTS: Perfusion imaging identified defects in 16 (89%) patients, of whom 15 (83% of total) were found to be ischemic. Stress echocardiography identified a fixed wall motion abnormality in 17 (94%) and ischemia in 8 (44%, p < 0.05 compared with perfusion imaging ischemia). Among 11 patients who underwent catheterization, there was a trend towards perfusion imaging identifying more ischemia in the territory of an obstructed (> or = 70%) vessel--100% (11/11) vs. 64% (7/11) for stress echocardiography (p = 0.09). CONCLUSION: In the immediate post-infarction period, dipyridamole stress radionuclide myocardial perfusion imaging more often shows evidence of residual ischemia than dobutamine stress echocardiography.