99mTc-HL91和Tl-201双核素心肌显像在冠心病中的初步临床研究

目的 探索^99mTc-HL9乏氧心肌显像在冠心病中的可行性及临床应用价值。方法3例急性心肌梗塞,1例不稳定性心绞痛连续病例行Tl-201和^99mTc-HL9双核素心肌显像，比较两种核素心肌显像、阳性节段数以及匹配方式。结果 ^99mTc-HL9可以提供较清晰的乏氧心肌图像并用于心肌节段分析；3例急性心肌梗塞，1例不稳定性心绞痛患共68个节段。Tl-201判断为阳性节段23个，占34％；^99mTc-HL9判断为阳性节段36个，占53％；24小时Tl-201延迟显像显示为可逆性分布7个节段，^99mTc-HL91均呈阳性显像；^99mTc-HL9比Tl-201多判断出13个阳性节段，占19％。双核素心肌显像有4种匹配方式：Tl-201正常^99mTc-HL9无显像，25个节段；Tl-201正常^99mTc-HL9显像。20个节段；Tl-201异常^99mTc-HL9显像，16个节段；Tl-201异常／99mTc-HL91无显像，7个节段。即刻Tl-201显像示23个异常节段。其中16个节段呈^99mTc-HL9阳性显像，占70％，24小时Tl-201延迟显像显示有7个(部分)可逆性节段。占30％，^99mTc-HL9检测缺血，存活心肌的能力显高于Tl-201(P=0．008)。结论^99mTc-HL9可以用于冠心病的心肌乏氧成像并用于心肌节段分析．乏氧显像为研究冠心病提供了新的手段。尚需大样本的临床研究。

A preliminary clinical study of dual isotope imaging of 99mTc-HL91 and T1-201 in coronary artery diseases

Objective To explore the feasibility of hypoxia imaging of myocardium tissues and its clinical values in coronary artery disease patients with 99mTc-HL91. Methods 3 acute myocardial infarction(AMI) and 1 unstable angina pectoris(UA) consecutive patients underwent dual isotope imaging of Tl-201 and 99mTc-HL91, and two kinds of myocardial imaging, positive myocardial segments and matching ways were compared. Results 99mTc-HL91 had provided pretty discernible hypoxia imaging of myocardial tissues in AMI and UA patients for further myocardial segment analysis. There had been 23 positive segments by Tl-201, taking up 34% while there had been 36 positive segments by 99mTc-HL91, taking up 53%, with additional 13 positive segments estimated by 99mTc-HL91, taking up 19%. There have been 7 reversible segments on 24h-Tl-201 delayed imaging, which were also manifest on 99mTc-HL91 hypoxia imaging. Dual isotope imaging of Tl-201 and 99mTc-HL91 includes 4 matching ways: normal Tl-201 imaging/negative 99mTc-HL91imaging, with 25 segments;normal Tl-201 imaging /positive 99mTc-HL91imaging,with 20 segments;abnormal Tl-201 imaging/ positive 99mTc-HL91 imaging,with 16 segments;abnormal Tl-201 imaging / negative 99mTc-HL91 imaging,with 7 segments. There were 7 (partially) reversible segments (ischemic/viable segments) on 24-hour-delayed-Tl-201 imaging and 16 positive segments on 99mTc-HL91 imaging among 156 abnormal segments based on immediate Tl-201 imaging, in which the 40 (partially) reversible segments were all positive of hypoxia imaging. The Tl-201 detection rate was 30%, and the 99mTc-HL91, 70%, with the latter being significantly higher than the former(P=0.008). Conclusion A new imaging method with hypoxic tracer of 99mTc-HL91 has been introduced and its potential clinical values have been manifest on the basis of this preliminary study. Large scale studies are warranted.