运动试验~18F-FDG心肌代谢显像诊断心肌缺血  

Diagnostic value of exercise induced ~18F-FDG myocardial metabolism scintigraphy in myocardial ischemia

作　　者：沈锐[1] 何作祥[1] 史蓉芳[1] 刘秀杰[1] 吴永健[2] 田月琴[1] 郭风[1] 魏红星[1] 秦学文[2] 高润霖[2] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院核医学科,北京100037 [2]中国医学科学院中国协和医科大学阜外心血管病医院心内科,北京100037

出　　处：《中华核医学杂志》2006年第5期276-279,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的探讨运动试验同时行 ^(18)F-脱氧葡萄糖(FDG)心肌代谢和^(99)Tc-~m-甲氧基异丁基异腈(MIBI)心肌灌注显像判断心肌缺血的可行性和诊断价值。方法 26例既往无心肌梗死病史的确诊或怀疑冠心病患者,在运动试验高峰或出现终止指标时注射^(99)Tc^m-MIBI 和^(18)F-FDG,进行心肌灌注和代谢显像,随后进行静息^(99)Tc^m-MIBI 心肌灌注显像以及冠状动脉造影。比较运动^(18)F-FDG 心肌代谢显像和^(99)Tc^m-MIBI 心肌灌注显像及冠状动脉造影结果。结果 22例有1支及其以上冠状动脉狭窄≥50%的患者中,18例出现血流灌注异常,灵敏度为82%,20例患者有明显^(18)F-FDG 摄取,灵敏度为91%,两者比较差异无显著性(X^2=1.497,P=0.338)。静息^(99)Tc^m-MIBI 心肌灌注显像示完全(12例)或部分(3例)可逆性心肌灌注缺损(心肌缺血)的患者同时行运动试验^(99)Tc^m-MIBI 心肌灌注、^(18)F-FDG 心肌代谢显像,表现为血流灌注减低的心肌节段^(18)F-FDG 摄取增加。与冠状动脉造影对比,22例患者共51个病变血管(管腔狭窄≥50%)支配的心肌节段中,运动试验^(99)Tc^m-MIBI 心肌灌注显像发现了25个节段,灵敏度为49%,而运动^(18)F-FDG 心肌代谢显像发现了34个节段,灵敏度为67%(X^2=7.30,P=0.008)。结论运动试验引起心肌缺血可以进行^(18)F-FDG 心肌代谢显像。且与单纯运动/静息心肌灌注显像比较,同时行运动试验^(99)Tc^m-MIBI 心肌灌注和^(18)F-FDG 心肌代谢显像对诊断局部缺血心肌节段有更高的准确性。Objective To evaluate the feasibility and diagnostic accuracy of exercise induced myocardial imaging with ^18F-fluorodeoxyglucose （FDG） in myocardial ischemia. Methods Twenty-six patients with known or suspected coronary artery disease （CAD） and with no prior myocardial infarction underwent simultaneous myocardial perfusion and metabolism imaging following intravenous injection of ^99Tc^m-methoxyisobutylisonitrile （^99Tc^m-sestamibi） and ^18F-FDG at peak exercise. Subsequently rest perfusion imaging and coronary angiography （CAG） were performed in all patients. Exercise ^18F-FDG myocardial imaging was compared with ^99Tc^m-sestamibi imaging and CAG. Results In 22 patients with ≥50% narrowing over 1 coronary artery, 18 had perfusion abnormalities （ sensitivity 82% ） , whereas 20 had abnormal myocardial ^18F-FDG uptake （ sensitivity 91%, P 〉0.05）. Patients with reversible （ 12 cases） or partial reversible （3 cases） perfusion abnormalities had increased myocardial ^18F-FDG uptake in abnormal perfusion segments. Compared with CAG, perfusion defect was seen in myocardial segments corresponding to 25 vascular territories of 51 vessels with t〉50% narrowing in 22 patients in ^99Tc^m-sestamibi imaging （ sensitivity 49% ） , whereas increased ^18F-FDG uptake was seen in 34 vascular territories （ sensitivity 67%, P = 0. 008 ）. Conclusions Exercise induced myocardial ischemia can be imaged directly with ^18F-FDG. Combined exercise ^18F-FDG and ^99Tc^m-sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia as compared with exercise-rest perfusion imaging.

关 键 词：心肌缺血 运动试验 体层摄影术 发射型计算机 单光子 脱氧葡萄糖 

分 类 号：R817.4[医药卫生—影像医学与核医学] R541.4[医药卫生—放射医学]