双核素心肌显像预测PCI术后心功能改善的评价  

Prognosis of Left Ventricular Ejection Fraction Improvement After PCI by Nitroglycerin Augmented 99Tcm-MIBI and 201Tl Dual-isotopic Myocardial Perfusion Imaging

作　　者：谢文晖[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 [2]上海交通大学附属仁济医院核医学科

出　　处：《中国医学计算机成像杂志》2010年第3期250-254,共5页Chinese Computed Medical Imaging

基　　金：上海市重点学科建设项目(S30203)~~

摘　　要：目的:探讨多巴酚丁胺201Tl负荷-再分布/硝酸甘油介入99Tcm-MIBI门控心肌灌注显像预测PCI术后心功能改善的作用。方法:69例临床怀疑有冠心病拟行经皮冠状动脉介入治疗(PCI)的病人进行多巴酚丁胺201Tl负荷-再分布显像,显像结束后行硝酸甘油介入99Tcm-MIBI门控心肌灌注显像。心肌显像后2周内69例病人全部进行了经皮冠状动脉介入治疗。PCI术前及术后3个月心脏超声测定左室射血分数(LVEF)。结果:①69例病人PCI术后左心室功能较术前有改善(△LVEF=4.78±2.4,t=2.02,P值<0.05)。②左心室功能降低组术后心功能提高值明显高于左心室功能正常组(△LVEF=5.3±2.0对LVEF=3.1±2.9,t=2.83,P<0.05)。③可逆性灌注缺损心肌节段数>3组术后心功能提高值明显高于可逆性灌注缺损心肌节段数≤3组(△LVEF=5.8±1.6对△LVEF=4.4±1.4,t=2.45,P<0.05)。结论:多巴酚丁胺201Tl负荷-再分布/硝酸甘油介入99Tcm-MIBI门控心肌灌注显像能准确检出缺血且存活心肌,对PCI术后心功能改善有很好的预测价值。Purpose：To evaluate the clinical value of dobutamine 201Tl stress-redistribution/Nitroglycerin augmented 99Tcm-methoxyisobutylisonitrile （MIBI） gated myocardial perfusion imaging（MPI） in predicting improvement of left ventricular ejection fraction after PCI.Methods：Sixty-nine patients with suspected coronary artery diseases（CAD）undertook dobutamine stress test before coronary interventions （PCI）.When the end point was achieved,111MBq 201TlCl was injected.Ten minutes later earlier period （10min） and delay period （4h） of myocardial tomography imaging were performed and at rest receiving sublingual nitroglycerin （NTG）,5min later 1110 MBq 99Tcm-MIBI was injected,90 min later ECG gatedmyocardium perfusion imaging was performed. After tomographic reconstruction,the images were interpreted by three experienced nuclear medical doctors without prior knowledge of results of other studies. Percutaneous coronary intervention was performed for 69 patients within two weeks. Pre-operative and post-operative left ventricular ejection fraction （LVEF）were obtained before and in three months after PCI.Results：①All of 69 patients,the improvement of postoperative LVEF was found（△LVEF=4.78±2.4,t=2.02,P0.05）.②More significant improvement of postoperative LVEF was foundin the dysfunction group than in the normal function group（△LVEF=5.3±2.0 vs △LVEF=3.1±2.9,t=2.83,P0.05）.③The improvement was better in the group of reversible defect segments 3 than in the group of reversible defect segments ≤3（△LVEF=5.8±1.6 vs △LVEF=4.4±1.4,t=2.4,P0.05）. Conclusion：Dobutamine 201Tl stress-redistribution/Nitroglycerin augmented 99Tcm-MIBI gated myocardial tomography imaging is able to detect ischemic and viable myocardium and predict the improvement of LVEF after PCI. It plays an important role in management of CAD.

关 键 词：活性心肌 201铊 99Tcm-甲氧基异丁基异腈 硝酸甘油 

分 类 号：R817.4[医药卫生—影像医学与核医学]