门控18F-FDG/99mTc-MIBI双核素显像评价冠脉搭桥术对心功能改善的作用

目的应用门控18F-FDG/99mTc-MIBI双核素显像评价陈旧性心肌梗死(MI)患者经冠脉搭桥(CABG)术对心功能改善的作用。方法31例陈旧性心肌梗死(MI)患者在冠脉搭桥术前及4个月后行18F-FDG及99mTc-MIBI DISA法显像。将左室心肌分为9个节段,根据术前显像结果分为灌注代谢匹配组(M)和不匹配组(MM),半定量法分别计算各节段99mTc-MIBI、18F-FDG摄取分数F值,评价局部心肌灌注、代谢情况,计算术前术后各种心功能参数包括EF、SV,观察整体心功能改善情况。结果31例患者,共分为279个节段;13例患者含有不匹配的节段108个,术前后99mTc-MIBI、18F-FDG摄取分数F值分别为1.71±0.44、1.22±0.31和2.33±0.72、1.50±0.50(P<0.01),术前后EF、SV值分别为(28.5±9.4)%、(47.1±17.0)ml和(34.2±9.7)%、(58.81±27.1)ml(P<0.05);18例患者含匹配的节段152个,术前后99mTc-MIBI、18F-FDG摄取分数F分别为1.51±0.44、1.23±0.31和1.60±0.50、1.34±0.22(P>0.05);术前后EF、SV值分别为(25.3±9.4)%、(45.6±17.0 ml)和(26.5±9.7)%、(46.81±27.1)ml(P>0.05)。结论冠脉搭桥术只能改善有存活心肌细胞的心室功能,而对无存活心肌细胞的心室功能无明显改善作用。

Investigation of Change in Heart Function with Gates Dual-isotope Imaging after CABG

Objective To investigate the change in global heart function with Gates 18F-FDG and 99mTC-MIBI dual-isotope imaging after coronary artery bypass graft(CABG) for myocardial infarction(MI).Methods A total of 31 patients with MI were enrolled in the study and underwent 18F-FDG and 99mTC-MIBI dual-isotope imaging before and four months after CABG.The left ventricular myocardium was divided into nine segments and was classified into two patterns by the results before CABG,i.e.myocardial perfusion-metabolism mismatch(MM) and match(M).The myocardial uptakes of 99mTC-MIBI and 18F-FDG were assessed by a 4-point scoring system to assess regional myocardial blood perfusion and glucose metabolism.EF and SV were measured for the investigation of global function.Results The 31 patients'myocardia were divided into 279 segments.In the 108 segments(13 patients) of the MM group,99mTc-MIBI and 18F-FDG uptake fractions four months after operation(2.33±0.72,1.50±0.50) were significantly higher than that before operation(1.71±0.44,1.22±0.31)(P<0.01).EF and SV before and after operation were [(28.5±9.4)%,(47.1±17.0) ml] and [(34.2±9.7)%,(58.81±27.1) ml],and the differences were significant(P<0.05).In the152 segments of non-transplanting group,99mTc-MIBI and 18F-FDG uptake fractions were(1.60±0.50,1.34±0.22) four months after operation and(1.51±0.44,1.23±0.31) before operation,and the differences were neither significant(P>0.05).EF and SV before and after operation were [(25.3±9.40)%,(45.6±17.0) ml] and [(26.5±9.7)%,(46.81±27.1) ml],which showed no significant difference(P<0.05).Conclusion CABG can improve the function of survival myocardial segments,but is helpless to infarcted myocardia.