核素门控心血池显像与心肌断层显像在冠心病诊断中的对比

笔者对１３４例冠心病患者的门控心血池显像（ＧＣＢＰ）与心肌断层显像结果进行了对比分析。结果显示：在心肌梗塞的诊断中，两种方法均有很高的灵敏度与特异度，单项检查均可达到诊断目的。ＧＣＢＰ显示室壁瘤较心肌断层更直观。在心肌缺血诊断中，心肌断层准确可靠，灵敏度为７９．２％，特异度为１００％。ＧＣＢＰ诊断心肌缺血只要掌握合适的标准其灵敏度与特异度与心肌断层相近，在检出病支血管方面心肌断层较ＧＣＢＰ更准确。     

应用门控SPECT测量左心室功能的方法学研究

目的：试用门控心肌显像测定左室功能并与心血池显像结果比较。材料和方法：61例受检者进行了Tc-99m—MIBI门控心肌显像及心血池显像．结果：门控断层心肌显像的短轴中间部左室功能结果与平衡法心血池显像有良好的相关性(r=0．82）。结论：门控心肌断层显像测定的左室功能结果方法简便可靠．能同时反映心肌直流及左室功能。     

门控心肌灌注断层显像、平衡法心血池显像和心动超声图测定左室射血分数的比较

目的：探讨门控心肌灌注断层显像（GMPT）、平衡法心血池显像（GBPI）与心动超声（UCG）测定左室射血分数（LVEF）的差别。材料和方法：入选冠心病患者10例，非冠心病患者12例，在72h内完成GMPT、GBPI和UCG检查，获得LVEF值。结果：三种方法测得的LVEF存在显著差异，UCG测得的LVEF明显高于GBPI和GMPT（P均小于0．01）。三种方法测得的LVEF有很好的相关性（P均小于0．01）；GMPT—GBPI之间和GBPI—UCG之间的相关性在冠心病组明显低于非冠心病组（r值分别为：0．640对0．912和0．670对0．892）。结论：GMPT、GBPI和UCG三种方法测定的LVEF在数值上存在差异，GBPI在冠心病患者中应用价值高于另外两种方法。     

门控心血池显像检测室壁瘤(与超声心动图对比)

本文采用平衡法门控心血池显像（ＭＧＢＰ）检测了正常对照组１５例，室壁瘤组２０例及非室壁瘤组２３例，对比分析了三组的心功能参数，结果示这到场且及非室壁瘤组的ＬＶＥＦ、ＰＥＲ、ＥＦ２－４，ＲＳ２－４、相角程与正常对照组比较均差异有显著性意义（Ｐ〈０．０５－０．０１）；室壁瘤与非室壁瘤之间的差异亦有显著性意义（Ｐ〈０．０５）；并且分析了门控心血池中室壁瘤的表现及与非室壁瘤的区别，其中１７例室壁瘤患者进行     

201Tl定量门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测定左心室射血分数的对比研究

目的 探讨201Tl定量门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测量左心室射血分数(LVEF)的相关性.方法 72例受检者接受201Tl静息门控心肌灌注体层显像,用AUTOQUANT 4.21软件测量LVEF,并与24 h内的静息99mTc-红细胞平衡法门控心血池显像结果进行比较.结果 ①门控心肌灌注体层显像与门控心血池显像测量LVEF值的结果呈明显正相关(r=0.554,P=-0.000),两种方法无统计学差别(t=1.194,P＞0.05).②不同疾病组之间两种测量方法无统计学差异(P值均大于0.05).③门控心肌灌注体层显像及门控心血池显像测量的LVEF值分别为(64.68±10.77)%和(62.46±8.99)%,门控心肌灌注体层显像测量的LVEF值要比门控心血池显像高出3.55%.结论 201Tl门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测量LVEF值的相关性好且结果准确,但门控心肌灌注体层显像的LVEF测量值要稍高于门控心血池显像.     

门控99Tcm-MIBI/18F-FDG双核素同时采集显像评价左心室功能

目的探讨门控99Tcm-甲氧基异丁基异腈(MIBI)/18F-脱氧葡萄糖(FDG)双核素同时采集(DISA)显像评价左心室功能的临床价值.方法 77例冠心病患者行门控DISA,其中53例行X线左心室造影(LVG),分别比较LVG心室射血分数(EF)值和DISA法门控99Tcm-MIBI和18F-FDG 同时显像所得EF值.局部室壁运动行Kappa值比较.结果门控99Tcm-MIBI和门控18F-FDG显像所得EF值间相关性高(r=0.90,P<0.001).两者与LVG EF值相关性均高(r分别为0.86和0.85,P均<0.001).门控99Tcm-MIBI和18F-FDG显像与LVG比较Kappa值分别为0.765和0.742.结论门控99Tcm-MIBI/18F-FDG DISA可同时了解左室心肌灌注、代谢及功能,提供左心室功能的重要信息,有重要的临床价值.     

20lTl定量门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测定左心室射血分数的对比研究

目的 探讨20lTl定量门控心肌灌注体层显像与99mTc-红细胞门控心血池显像测量左心室射血分数(LVEF)的相关性。方法 72例受检者接受20lTl静息门控心肌灌注体层显像,用AUTOQUANT 4.21软件测量LVEF,并与24h内的静息99mTc-红细胞平衡法门控心血池显像结果进行比较。结果 ①门控心肌灌注体层显像与门控心血池显像测量LVEF值的结果呈明显正相关(r=0.554,P=0.000),两种方法无统计学差别(t=1.194,P>0.05)。②不同疾病组之间两种测量方法无统计学差异(P值均大于0.05)。③门控心肌灌注体层显像及门控心血池显像测量的LVEF值分别为(64.68±10.77)%和(62.46±8.99)%,门控心肌灌注体层显像测量的LVEF值要比门控心血池显像高出3.55%。结论 20lTl控心肌灌注体层显像与99mTc-红细胞门控心血池显像测量LVEF值的相关性好且结果准确,但门控心肌灌注体层显像的LVEF测量值要稍高于门控心血池显像。     

平衡法心血池显像检测心室局部收缩功能及局部室壁运动

本研究运用门控平衡法心血池显像(MGBP)观察了心肌梗塞组(MI)30例,原发性高血压病组(EH)20例及对照组(N)15例三组的左室局部射血分数(EF_1—EF_5)及局部轴缩短率(RS_1—RS_5)的变化,发现 MI 组的局部 EF 及 RS的变化与梗塞部位相符(40/46、85%),与 N 组比较各部位EF与RS均有显著性差异(P<0.05—0.001).EH组与N组比较除EF_4、RS_4的差异有显著性意义(P<0.05)以外,其余EF、RS两组的差异无显著性意义(P>0.05),提示左室局部EF及RS改变对于判断MI及EH的病变部位和病情变化有确定的应用价值.三组各部位EF与RS均呈正相关关系(P<0.05—0.001).     

门控心肌显像对心脏起搏器植入早期左心室功能和结构的研究

目的 应用门控心肌显像观察心脏起搏器植入后早期患者左心室收缩功能与结构的变化.方法 患者27例,男9例,女18例,年龄(65.1±9.5)岁.其中起搏心室感知心室R波抑制型(VVI)起搏器组15例,起搏双腔感知双腔P波或R波抑制型(DDD)起搏器组12例.采用门控心肌显像方法测定患者起搏器植入前及植入后早期[随访(4.6±1.5)个月]自身心律或起搏器工作状态下左心室功能参数值:左心室射血分数(LVEF),左心室舒张末容积(EDV),左心室收缩末容积(ESV)及左心室收缩时间.按左心室室壁活动靶心图将室壁活动度分为缺损、稀疏及正常3级.植入前后相比,有下列一项即为左心室功能重构:LVEF增加或降低10%及以上,室壁活动度改变1级及以上,左心室收缩时间延长或缩短1个时间段及以上;结构重构:EDV增加或降低10%以上.结果 (1)左心室功能重构:27例患者中,26例(96.3%;VVI组15例,DDD组11例)出现功能重构.26例中6例(23.1%;VVI组4例,DDD组2例)LVEF升高,8例(30.8%;VVI组4例,DDD组4例)LVEF降低,12例(46.2%;VVI组7例,DDD组5例)LVEF无变化.(2)结构重构:27例中13例(48.1%;VVI组10例,DDD组3例)出现结构重构.13例中4例(VVI组3例,DDD组1例)LVEF升高,3例(均为VVI组患者)LVEF降低,6例(VVI组4例,DDD组2例)LVEF无变化.结论 心脏起搏器植入后早期即可发生左心室功能重构,约半数患者出现左心室结构重构.心脏永久起搏器植入在患者心脏获得电生理学益处时,可能对左心室的功能和结构带来不利影响.     

Stress-related variations in left ventricular function as assessed with gated myocardial perfusion SPECT

BACKGROUND: There is inconsistency in reported patient characteristics associated with differences in basal and poststress left ventricular function (delta ejection fraction [DeltaEF]) assessed by gated single photon emission computed tomography (SPECT). This inconsistency may therefore hamper adequate interpretation. In this study we first determined the reproducibility of serial gated SPECT-assessed left ventricular function. Second, we determined whether left ventricular ejection fraction (LVEF) assessed directly after stress reflects basal LVEF and, if not, what patient characteristics were associated with this discrepancy in LVEF. METHODS AND RESULTS: Serial reproducibility of technetium 99m tetrofosmin gated SPECT-assessed LVEF in 22 patients showed a mean difference between two sequential measurements at rest of 0.09% EF units, with a 95% limit of agreement (2 SDs) at 5.8% EF units. In 229 patients Tc-99m tetrofosmin gated SPECT was performed after stress and at rest. Independent predictors of DeltaEF were the presence of scintigraphically proven ischemia (standardized coefficient, -1.256; P =.003) and difference in heart rate at the time of acquisition (standardized coefficient, 0.121; P =.001). CONCLUSIONS: Gated SPECT-assessed LVEF at rest is reproducible under standard clinical conditions. However, LVEF assessed after stress does not represent LVEF at rest in patients with scintigraphically proven ischemia and in patients with increased heart rate after stress compared with heart rate at rest.     

定量门控99Tcm-tetrofosmin心肌显像测量左室功能

目的探讨定量门控(QG)99Tcm-tetrofosmin心肌显像测量左室功能的临床应用价值.方法74例受试者进行了门控99Tcm-tetrofosmin心肌显像,采用QGSPECT专用分析程序全自动测量左室功能.其中36例同时进行静息门控心室显像,以比较两种方法测量左室功能的相关性.结果①74例99Tcm-tetrofosminQGSPECT全自动定量测定左室功能均获成功.②QGSPECT全自动测量36例受试者的静息左室射血分数(LVEF)、舒张末期容积(EDV)、收缩末期容积(ESV)分别与静息门控心室显像计算结果显著正相关(r分别为0.859,0.914,0.950,P均<0.001),重复性好.③心肌缺血组(n=28)静息LVEF与对照组(n=23)比较差异无显著性,而心肌梗死组(n=9)静息LVEF明显低于对照组(t=6.33,P<0.001).结论定量门控心肌显像99Tcm-tetrofosmin能准确评价左室功能.     

Comparison of three commercially available softwares for measuring left ventricular perfusion and function by gated SPECT myocardial perfusion imaging

Background

The three softwares, Quantitative Perfusion SPECT (QPS), Emory Cardiac Toolbox, and 4 Dimension-Myocardial SPECT (4DM) are widely used with myocardial perfusion imaging (MPI) to determine perfusion defect size (PDS) and left ventricular (LV) function. There are limited data on the degree of agreement between these methods in quantifying the LV perfusion pattern and function.

Methods and Results

In 120 consecutive patients who had abnormal regadenoson SPECT MPI with a visually derived summed stress score ≥4, the correlation between the softwares for measurements of PDS, reversible, and fixed defects was poor to fair (Spearman’s ρ = 0.18-0.72). Overall, estimation of defect size was smaller by QPS and larger by 4DM. There was discordance among the softwares in 62% of the cases in defining PDS as small/moderate/large. The correlation between the softwares was better for measuring LVEF, volumes and mass (ρ = 0.84-0.97), and discrepant results for defining normal/mild-moderate/severe LV systolic dysfunction were prevalent in 28% of the patients.

Conclusion

There are significant differences between the softwares in measuring PDS as well as LV function, and more importantly in defining small, moderate, or large ischemic burden. These results suggest the necessity of using the same software when assessing interval changes by serial imaging.     

A comparison and validation of blood-pool imaging and ECG-gated SPET myocardial perfusion imaging to assess left ventricular ejection fraction

The aim of this study was to validate the accuracy of left ventricular ejection fraction (LVEF) obtained by quantitative gated single photon emission tomography (QGS) perfusion imaging in comparison with gated blood-pool imaging. Resting gated myocardial perfusion imaging was performed in 269 patients with suspected or known coronary artery disease, and followed by equilibrium nuclear cardiac blood-pool imaging in one week. The later was considered as the reference standard. The LVEF from both methods were analyzed. The LVEF were calculated with QGS using Cedars Cardiac Quantification software. We found that LVEF from QGS and blood-pool (Bp)-LVEF were highly correlated (r=0.819, <0.001). Taken into consideration that QGS-LVEF was significantly different from Bp-LVEF (mean ± SD: 57.77% ± 19.28% vs 54.23% ± 15.41%, P<0.05), data were further analyzed by grouping participants based on end-systolic ventricular volume (ESV). QGS-LVEF was not significantly different from Bp-LVEF in the group where that ESV was larger than 15m, (mean ± SD: 52.71% ± 16.11% vs 51.83% ± 15.33%, P>0.05), whereas when ESV was smaller than 15 mL, QGS-LVEF was significantly higher than Bp-LVEF (mean ± SD: 80.53% ± 7.01%vs 65.06% ± 10.37%, P<0.05). Our findings demonstrate that when ESV values are larger than 15 mL, QGS- LVEF could replace Bp-LVEF. However, when ESV value is smaller than 15 mL, LVEF should be assessed in combination with blood-pool imaging.     

Risk stratification of patients with prior myocardial infarction and advanced left ventricular dysfunction by gated myocardial perfusion SPECT imaging

Background. The Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) has shown that the prophylactic implantable cardiac defibrillator improves the survival rate of patients with prior myocardial infarction and advanced left ventricular (LV) dysfunction. However, a more accurate noninvasive predictor should be found to identify subgroups at high risk, one that would allow implantable cardiac defibrillator therapy to be directed specifically to the patients who would benefit most. Methods and Results. To elucidate whether technetium 99m tetrofosmin electrocardiogram-gated single photon emission computed tomography (SPECT) imaging at rest can determine the risk of arrhythmic death, 106 patients who met the MADIT-II criteria (LV ejection fraction ≤0.3, myocardial infarction τ;1 month earlier, and no sustained ventricular tachyarrhythmia) were recruited from a pool of 4628 consecutive patients who had undergone resting Tc-99m tetrofosmin SPECT imaging. By use of the endpoints of lethal arrhythmic events, which included documentation of sustained ventricular tachycardia, ventricular fibrillation, or diagnosis of sudden cardiac death, we performed follow-up for a mean of 30 months. Lethal arrhythmic events occurred in 14 patients. Patients with lethal arrhythmic events had a lower LV ejection fraction, greater LV end-systolic and end-diastolic volume indices, and a greater perfusion defect volume than the remaining patients. By receiver operating characteristic curve analysis, myocardial defect volume was the strongest predictor for the development of lethal arrhythmic events. Conclusion. Our results confirm that perfusion defect volume by Tc-99m tetrofosmin scintigraphy is the most pivotal predictor of the future occurrence of lethal arrhythmic events and of sudden cardiac death. Tc-99m tetrofosmin SPECT images may assist in identifying subsets of patients with a greater likelihood of arrhythmic death among patients with LV dysfunction.     

Evaluation of left ventricular function using gated planar myocardial imaging with Tc-99m-MIBI

A quantitative index of left ventricular wall motion obtained from ECG-gated planar myocardial images has been developed. Five normal controls and 39 patients with heart disease received an injection of Tc-99m-MIBI (550-740 MBq) at rest, and ECG-gated planar scintigraphy (LAO view) was performed 3 h later. Mean End-diastolic (ED) and end-systolic (ES) myocardial activities were measured using circumferential profile analysis and %count increase (CI) was determined according to the following formula; (ES count-ED count)/(ED count) x 100. The global %CI was compared with the EF obtained from contrast ventriculography (LVG; n = 29) and radionuclide ventriculography using Tc-99m-labelled RBC (RNV; n = 24). The regional %CI was compared with left ventricular wall motion assessed by LVG. The global %CI was correlated well with EF by LVG (r = 0.70) and EF by RNV (r = 0.75). The regional %CI significantly decreased in accordance with wall motion on LVG worsened at impaired region. In conclusion, gated perfusion imaging with Tc-99m-MIBI provides useful information on ventricular function in addition to myocardial perfusion.     

The evaluation of left ventricular dyssynchrony in hypertensive patients with a preserved systolic function undergoing gated SPECT myocardial perfusion imaging

Annals of Nuclear Medicine - Hypertension as a known risk factor for cardiovascular diseases can result in left ventricular dyssynchrony (LVD) leading to uncoordinated contraction. The aim of our...     

Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies

Background  

The purpose of this study was to establish the repeatability of left-ventricular (LV) dyssynchrony and function parameters measured from serial gated myocardial perfusion SPECT (GMPS) studies.