成人急性病毒性心肌炎核素心肌显像的初步探讨  

Radionuclide myocardial perfusion imaging of acute viral myocarditis in adults

作　　者：陈良[1] 蒋锦琪[1] 林启蓉[1] 谢文晖[2] 

机构地区：[1]上海交通大学附属胸科医院急诊科,上海市200030 [2]上海交通大学附属胸科医院核医学科,上海市200030

出　　处：《中华老年多器官疾病杂志》2009年第5期429-432,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的观察成人急性病毒性心肌炎患者的双嘧达莫负荷心肌201Tl SPECT显像特点,初步探讨其显像机制及其临床意义。方法选取临床符合急性病毒性心肌炎的成人患者4例,按体重0.56mg/kg予双嘧达莫针剂,于4min内静脉注射,10min及240min后分别进行双嘧达莫负荷心肌201Tl SPECT显像,原始图像经三维重建后由2位以上有经验的核医学科医师进行分析。结果4例患者中有3例的负荷图像显示为左室心肌放射性分布正常而延迟图像显示为局部心肌反向放射性分布稀疏(1例为下壁,1例为心尖部、下壁和前壁,1例为前壁),即"反向再分布";有1例患者显示为负荷图像和延迟图像固定性的下壁局部心肌放射性分布稀疏。结论双嘧达莫负荷心肌201Tl SPECT显像对于成人病毒性心肌炎的诊断具有一定的参考价值,而"反向再分布"的存在与心脏微血管功能障碍密切相关。Objective To observe the characteristics of dipyridamole stress ^201Tl SPECT myocardial imaging in adult patients with acute viral myocarditis, and to preliminarily explore its mechanism and clinical significance. Methods Four adults with acute viral myocarditis were chosen. Dipyridamole was administrated at 0.56mg/kg by intravenous injection within 4min. Images were acquired after 10min and 240min respectively. Three-dimensional reconstructions of the original images were analyzed by more than two experienced nuclear medicine physicians. Results In all of the four patients, three myocardial imagings showed the radioactive uniformity at stress stage but the radioactive defect at delayed stage in left ventriclar myocardium（one in inferior wall; one in apex, inferior and anterior wall; one in anterior wall） ,namely reverse redistribution. And the imaging of the other one showed the fixed radioactive defect in inferior wall both at stress and delayed stage. Conclusion Dipyridamole stress ^201Tl SPECT myocardial imaging has certain value in the diagnosis of acute viral myocarditis of adults. The mechanism of reverse redistribution in dipyridamote stress ^201Tl SPECT myocardial imaging is primarily relevant to the dysfunction of cardiac microcirculation.

关 键 词：成年人 心肌炎 病毒 201Tl SPECT显像 双嘧达莫 

分 类 号：R542.210.5[医药卫生—心血管疾病] R541.4[医药卫生—内科学]