双嘧达莫负荷心肌^201TlSPECT显像诊断冠状动脉微循环障碍的价值  

Value of dipyridamole stress ^201Tl myocardial SPECT in detecting dysfunction of coronary microcirculation

作　　者：娄樱[1] 蒋锦琪[1] 谢文晖[2] 袁方[3] 王彤[1] 杨奕清[3] 

机构地区：[1]上海交通大学附属胸科医院急诊科,200030 [2]上海交通大学附属胸科医院核医学科,200030 [3]上海交通大学附属胸科医院心内科,200030

出　　处：《中华核医学与分子影像杂志》2012年第5期358-362,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：上海市科学技术委员会科研计划项目（05ZR14106）

摘　　要：目的探讨双嘧达莫负荷心肌^201TlSPECT显像在诊断冠状动脉微循环障碍中的价值。方法选取临床符合心脏X综合征诊断标准的患者共48例，按患者体质量0．56mg,／kg予双嘧达莫针剂静脉注射（4mln），在心脏负荷达高峰后注人^201Tl111MBq，10min及240min后分别进行心肌^201TlSPECT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。对出现“反向再分布”现象的患者采用山莨菪碱（654-2）治疗2周后，再次进行双嘧达莫负荷心肌^201TlSPECT显像，同时比较患者治疗前后临床症状和平板运动试验结果。结果48例患者中有42例延迟（240min）显像时均显示部分心肌节段反向放射性分布稀疏或缺损，即“反向再分布”，检出阳性率为87．50％（42／48）。在42例出现“反向再分布”现象的患者中，治疗后临床症状及平板运动试验结果均有改善的36例患者再次进行延迟（240min）显像时原受累的49个节段中有45个节段放射性分布有不同程度改善，检出阳性率达91．84％（45／49）。两者有1项未改善或2项均未改善的6例患者延迟（240min）显像时原受累的7个节段放射性分布无改善。结论双嘧达莫负荷心肌^201TlSPECT显像对诊断以心脏x综合征为代表的冠状动脉微循环障碍疾病有一定的价值。Objective To evaluate the value of dipyridamole stress^201T1 myocardial SPECT in de- tecting dysfunction of coronary microcirculation. Methods Forty-eight patients diagnosed with cardiac syn- drome X underwent dipyridamole stress ^201T1 myocardial SPECT. Dipyridamole （0.56 mg/kg） was intrave- nously injected over 4 rain followed by ^201Tl （111 MBq） injection at 2 min after dipyridamole administra- tion. Image was acquired at 10 rain and 240 rain post-injection and co-analyzed by over two experienced doctors in nuclear medicine after three-dimensional reconstruction. The patients with ＂ reverse redistribu- tion＂ underwent repeated dipyridamole stress ^201Tl SPECT after medical therapy for 2 weeks. The clinical symptoms and results of the treadmill exercise test pre- and post- therapy were compared. Results Forty- two patients （42/48, 87.50% ） showed segmental defects： ＂reverse redistribution＂ on delayed （240 min）^201Tl images. After medical treatment, 36 cases of the 42 ＂reverse redismbution＂ patients had improvement in both clinical symptoms and treadmill exercise test. Post-treatment ^201Tl imaging showed improvement in 45/49 （91.84%） defect segments. Six of the 42 patients had no improvement in clinical symptoms and/or treadmill exercise test. Post-treatment ^201Tl imaging showed no improvement in all the 7 defect segments on the first scan. Conclusion Dipyridamole stress ^201Tl myocardial SPECT may be valuable in evaluation of impaired coronary microcirculatian associated with cardiac syndrome X.

关 键 词：微血管性心绞痛 体层摄影术 发射型计算机 单光子 双嘧达莫 铊放射性同位素 

分 类 号：R541.4[医药卫生—心血管疾病]