硝酸甘油介入~(99m)锝─甲氧基异丁基异腈心肌灌注显像识别存活心肌及对急性心肌梗塞血运重建术疗效评价

目的：探讨硝酸甘油（ＮＴＧ）介入９９ｍ锝—甲氧基异丁基异腈（９９ｍＴＣ－ＭＩＢＩ）心肌灌注显像评价存活心肌、指导经皮冠状动脉腔内成形术（ＰＴＣＡ），把握适应证及判定ＰＴＣＡ疗效的应用价值。 方法：对２３例行ＰＴＣＡ的急性心肌梗塞患者进行术前静息９９ｍＴＣ－ＭＩＢＩ心肌灌注显像、ＮＴＧ介入９９ｍＴＣ－ＭＩＢＩ心肌灌注显像和术后１周、２个月静息９９ｍＴＣ－ＭＩＢＩ心肌灌注显像，采用４点积分法半定量分析９９ｍＴＣ－ＭＩＢＩ的摄取。根据放射性异常程度不同将受累心肌节段分为心肌存活节段，部分心肌存活节段、心肌无存活节段。 结果：ＮＴＧ介入９９ｍＴｃ－ＭＩＢＩ心肌灌注显像评价存活心肌的阳性预测值、阴性预测值和准确度，它们分别为８５．０％、８８．５％和８４．９％。ＰＴＣＡ后心肌存活节段和部分心肌存活节段放射性异常积分明显降低，心肌无存活节段未见显著变化。 结论：ＮＴＧ介入９９ｍＴｃ－ＭＩＢＩ心肌灌注显像能显著提高存活心肌的检出率，对急性心肌梗塞血运重建术的疗效判定及指导临床适应证的选择具有较高的应用价值。

Assessment of Viable Myocardium and Coronary Revascularization of Acute Myocardium Infarction by Nitroglycerin Infusion in Technetium~(99m) Hexakis-2-Methoxylisobutylisonitrile Myocardial Single Photon Emission Computed Tomography

Objective: To discuss the clinical value of nitroglycerin infusion by Technetium-99m hexakis-2- methoxylisobutylisonitrile (99m Tc-MIBI) myocardial single photon emission computed tomography (SPECT) in the detection of viable myocardial and evaluation of pereutaneous transluminal coronary angioplasty(PTCA) outcome. Methods: Twenty-three patients with coronary artery disease (CAD) were enrolled in our study for PTCA. Myocardial imaging was undertaken before PTCA. Rest imaging was repeated 1 week and 2 months after PTCA. Results:The positive and negative predictive values and the accuracy of nitroglycerin per fusion during 99mTc-MIBI myocardial SPECT in detecting viable myocardium were 85. 0%, 88. 5% and 84.9%, respectively. The ischemia score was reduced apparently after PTCA,most apparently in the ischemia group,apparently in the group of ischemia and infarction not apparently in the infarction group. Conclusions:Nitroglycerin perfusion during 99m Tc-MIBI myocardial SPECT might improve the detection of viable myocardial of much value in outcome and its clinical applications.