放射性核素心肌显像评价大动脉炎心脏受累

目的 评价放射性核素心肌显像在大动脉炎心脏受累患者中的应用价值.方法 回顾性分析12例临床确诊大动脉炎且有心脏受累,并接受了放射性核素心肌显像和冠状动脉造影患者的临床和心肌显像资料.12例患者中,男3例,女9例,年龄(35±15)岁.将12例患者的心脏受累分为单纯主动脉瓣受累(4例)和冠状动脉受累而无主动脉瓣受累(8例).单纯主动脉瓣受累的患者中,运动和药物负荷99Tcm-甲氧基异丁基异腈(MIBI)心肌灌注显像各1例,另2例进行了静息心肌灌注显像;冠状动脉受累的患者中,4例进行了心肌灌注显像(运动和药物负荷心肌灌注显像各1例,静息心肌灌注显像2例),另外4例进行了99Tem-MIBI和16F-脱氧葡萄糖(FDG)双核素心肌灌注-代谢显像.结果 单纯主动脉瓣受累的4例患者心肌灌注显像表现为左心室扩大,无明显的心肌灌注异常.冠状动脉受累的8例患者中,2例有可逆性心肌缺血,其余6例静息显像即有灌注受损,灌注受损的心肌可存活或不存活.结论 对于大动脉炎心脏受累的患者,放射性核素心肌显像可提供心室形态、心肌灌注和活力等方面的综合信息.

Evaluation of cardiac involvement using radionuclide myocardial imaging in patients with Takayasu arteritis

Objective The aim of the study was to assess the value of radionuclide myocardial imaging in the evaluation of cardiac involvement in patients with Takayasu arteritis (TA). Methods The 99Tcm-methoxyisobutylisonitrile myocardial perfusion imaging (MIBI-MPI) and (or) 18F-fluorodeoxyglucose (FDG) PET imaging findings in 12 TA patients 3 men and 9 women, mean age (35±15)years] with coronary lesions (CL; n=8) or aortic insufficiency (AI; n=4) were retrospectively reviewed and analysed. Of the 4 AI-TA patients. 1 underwent exercise MIBI-MPI. 1 underwent pharmacologic stress MIBI-MPI and 2 underwent resting MIBI-MPI. Of the 8 CL-TA patients. 4 underwent MIBI-MPI (2 stress and 2 rest)and 4 underwent a dual-isotope simultaneous acquisition (DISA) SPECT protocol after injection of MIBI and FDG. Results All 4 AI-TA patients showed left ventricular enlargement but no perfusion abnormalities. In 3 CL-TA patients with no documented infarct, MPI or DISA showed stress ischemia (n=2) or mismatched perfusion-metabolism defects (n=1). In the remaining 5 CL-TA patients with documented infarcts, 2 showed large perfusion defects on resting MIBI and 3 showed matched perfusion-metabolism defects on DISA SPECT. Conclusion Radionuclide imaging is useful in providing a comprehensive functional evaluation for TA patients with cardiac involvement.