^(201)Tl再注射心肌显像和再注射后延迟显像检测心肌存活的对比研究  

Comparative study of 201 Tl reinjection myocardial imaging and late imaging after reinjection for detecting myocardial viability

作　　者：林景辉[1] 柴晓峰[1] 朱玫 吴树燕[1] 潘中允[1] 张岭 聂韬 王彦福[1] 

机构地区：[1]北京医科大学第一医院核医学科

出　　处：《中华核医学杂志》1997年第3期146-149,共4页Chinese Journal of Nuclear Medicine

摘　　要：为了解２０１Ｔｌ再注射及再注射后延迟显像对心肌存活的检测能力，对６２例心肌梗塞患者进行了２０１Ｔｌ运动、３～５小时再分布、２０１Ｔｌ再注射后１６～３５分钟及再注射后１２～１９小时延迟心肌断层显像。１５例患者于显像后行经皮冠状动脉腔内成形术（ＰＴＣＡ），并于ＰＴＣＡ后重复运动再分布心肌显像。结果：６２例患者运动再分布显像共有１２６个不可逆缺损节段，其中４８个节段再注射后１６～３５分钟出现放射性填充，心肌存活检出率为３８１％（４８／１２６）；５１个节段再注射后延迟显像出现再分布，心肌存活检出率为４０５％（５１／１２６）。两种显像方案的检出率差异无显著性（χ２＝０１６，Ｐ＞００５），但两者结合６２个节段示有放射性填充，心肌存活检出率可提高到４９２％（６２／１２６）。１５例患者ＰＴＣＡ前共检出１７个心肌存活节段，术后１２个节段２０１Ｔｌ灌注改善，阳性预测率为７０６％；ＰＴＣＡ前检出１１个梗塞节段，术后９个节段２０１Ｔｌ摄取无改善，阴性预测率为８１８％。结果表明：２０１Ｔｌ再注射与延迟显像心肌存活检出率无明显差别，但两者联合应用可提高检出率。PURPOSE To compare 201 Tl reinjection imaging with late imaging in detecting myocardial viability METHODS62 patients with myocardial infarction underwent 201 Tl exercise, 3～5 hours redistribution, 16～35 minutes and 12～19 hours post 201 Tl reinjection myocardial tomography imaging After imaging, percutaneous transluminal coronary angioplasty (PTCA) were performed in 15 patients, and then exercise redistribution myocardial imaging were repeated [WT5”HZ]RESULTS 62 patients had 126 segments of irreversible defects on stress redistribution imaging, 48 segments showed radioactive filling at 16～35 minutes post reinjection The detecting rate of myocardial viability was 38 1% (48/126) 51 segments presented redistribution on 12～19 hours late imaging, the detecting rate of myocardial viability was 40 5% (51/126) There were no significant difference in the detecting rate between them (χ 2=0 16, P>0 05) But in combination of both methods, there were 62 segments refilling, thereby detecting rate was enhanced to 49 2% (62/126) In 15 patients who had PTCA, out of 17 segments were discovered to be viable before PTCA After PTCA 12 segments had an improved perfusion of 201 Tl, the positive predictive accuracy was 70 6%. Out of 11 segments were discovered to be infarcted, 9 segments had nonimproved 201 Tl perfusion after PTCA, the negative predictive accuracy was 81 8% CONCLUSIONS There were no significant difference in the detecting rate of myocardial viability between 201 Tl reinjection and late imaging In combination of both methods the detecting rate can be enhanced

关 键 词：心肌梗塞 放射性核素 显像 铊 心肌存活 

分 类 号：R542.22[医药卫生—心血管疾病]