双核素心肌显像检测存活心肌的对比研究  

The comparison of simultaneous dual-isotopic myocardial perfusion SPECT imaging in the detection of myocardial viability

作　　者：谢文晖[1] 张莉华[1] 蔡小佳[1] 雷贝[1] 黄钢[2] 

机构地区：[1]上海交通大学附属胸科医院核医学科,200030 [2]上海交通大学附属仁济医院核医学科

出　　处：《中华核医学杂志》2009年第2期122-125,共4页Chinese Journal of Nuclear Medicine

基　　金：基金项目：上海市重点学科建设项目（S30203）

摘　　要：目的对比多巴酚丁胺负荷201^Tl／静息99^Tc^m-甲氧基异丁基异腈（MIBI）双核素同步心肌断层显像及多巴酚丁胺负荷-再分布／再注射201^Tl心肌断层显像法检测存活心肌的作用。方法对160例临床怀疑有冠心病的患者予静息状态下静脉注射740MBq 99^Tc^m-MIBI，休息15min后进行多巴酚丁胺负荷试验，在达到终止指标时静脉注射111MBq 201^TlCl。注射后观察5～10min，分别行早期（10min）、延迟（3h）99^Tc^m-MIBI和201^Tl双核素同步心肌断层显像。对早期负荷201^Tl图像发现放射性缺损，延迟再分布201^Tl和静息99^Tc^m-MIBI图像未见放射性填充的患者再注射37MBq 201^TlC1，30min后行再注射心肌灌注显像。负荷201^Tl图像示放射性缺损，静息99^Tc^m-MIBI、再分布201^Tl及再注射201^Tl图像中发现任何一种放射性填充者均为存活心肌。断层显像后2周内全部患者进行了冠状动脉造影。采用SAS6．12软件进行Х^2检验。结果（1）160例患者冠状动脉造影均发现冠状动脉狭窄，其中单支病变76例、双支病变51例、三支病变33例。（2）152例多巴酚丁胺负荷201^Tl图像发现放射性缺损的患者中，63例201^Tl再分布和静息99^Tc^m-MIBI图像均发现放射性填充，5例201^Tl再分布发现放射性填充而静息99^Tc^m-MIBI图像未见放射性填充，9例静息99^Tc^m-MIBI图像发现放射性填充而。201^Tl再分布未见放射性填充，75例201^Tl再分布和静息99^Tc^m-MIBI图像均未发现放射性填充，负荷201^Tl-延迟再分布显像（66．0％，68／103）和负荷201^Tl／静息99^Tc^m-MIBI显像（69．9％，72／103）鉴别存活心肌的灵敏度差异无统计学意义（Х^2=0．36，P〉0．05）。（3）75例201^Tl再分布和静息99^Tc^m-MIBI图像均末发现放射性填充患者中，再注射201^Tl显像后有26例放射性填充，再注射201^Tl显像较单纯201^Tl再分布或静息99^Tc^m-MIBI显像多检测出34．7％（26／75）患者有�Objective Thecomparison of the clinical role of stress- redistribution/reinjection with dual isotopes of 99^Tc^m-methoxyisobutylisonitrile （MIBI） and 201^Tl in the detection of myocardial viability. Methods One hundred and sixty patients with clinically suspicious coronary artery disease （CAD） were included. All had intravenous injection with 740 MBq of 99^Tc^m-MIBI. Pharmacological challenge with dobutamine （5 μg·kg^-1·min^-1 ） was given to all at 15 min after injection of 99^Tc^m-MIBI. At the end of pharmacological challenge with dobutamine, 111 MBq of 201^Tl was injected to all. Myocardial SPECT images were performed in all at 10-min （stress） and 3-h （redistribution/rest） after injection. The 201^Tl （37 MBq） would be given to those patients with myocardial perfusion defect at stress images by 201^Tl and were demonstrated by both 201^Tl （redistribution） and 99^Tc^m-MIBI （rest）. Coronary angiography （CAG） was performed within two weeks, Х^2-test was used with SAS 6.12. Results Coronary artery abnormalities were found in all with 76 patients had one vessel disease, 51 had two and 33 had three. Of the 152 patients who had myocardial perfusion defect during stress images, 63 had redistribution by both 201^Tl and 99^Tc^m-MIBI, 5 had redistribution by 201^Tl only, 9 had redistribution by 99^Tc^m-MIBI only, and 75 had no redistribution in 201^Tl or 99^Tc^m-MIBI images. The sensitivity of detection myocardial viability with myocardial SPECT images between 201^Tl at redistribution （66.0%, 68/103） and 99^Tc^m-MIBI at rest （69.9%, 72/103） were insignificant （Х^2 = 0.36, P 〉 0.05 ）. Of the 75 patients who did not have redistribution in 201^Tl or 99^Tc^m-MIBI images, 34.7% （26/75） had myocardial perfusion when reinjection of 201^Tl. In all, there were eight false negative myocardial perfusion SEPCT images. Three were triple vessel disease, one was two, three were one, and the other was patent collateral circulation. Conclusions Stress-redistributed/reinjection 201^T

关 键 词：冠状动脉疾病 心肌 体层摄影术 发射型计算机 单光子 多巴酚丁胺 铊放射性同位素 MIBI 

分 类 号：R686[医药卫生—骨科学]