静息再注射^(201)TL心肌灌注显像估测心肌存活及在临床的应用价值  

REST-REINJECTION ^(201)TL IMAGING IN ASSESSING MYOCARDIAL VIABILITY AND ITS CLINICAL USEFULNESS

作　　者：毛金磊[1] 蒋茂松[1] 

机构地区：[1]华东医院核医学科,上海200040

出　　处：《老年医学与保健》2000年第4期188-190,共3页Geriatrics & Health Care

摘　　要：目的 探讨静息及再注射～２０１ＴＬ心肌血流灌注显像在估测病变区的存活心肌中的价值，以期能有助于治疗措施的选择和疗效的判断及术后随访。方法 对５０例冠心病患者进行静息及再注射～２１０ＴＬ心肌显像，对比前后两者病变心肌放射性核素的填充情况，以此来检测存活心肌（冬眠心肌或顿抑心肌）的存在，估计存活的范围和受损程度。结果５０例冠心病患者静息～２０１ＴＬ心肌显像结果显示，在３５０个室壁段中静息血流灌注异常的有９８个室壁段（２８％）。再注射～２０１ＴＬ心肌显像后，在３５０个室壁段中，５６个室壁段呈完全填充，２０个室壁般呈都份填充，可逆性血流灌注异常的室壁段占８０％，另有１０个室壁段（１０％）为不可逆缺损和１３个室壁段呈反向分布，其中３个室壁段在静息显像时血流灌注正常，再注射后出现反向分布。肺部摄取放射性核素随着受累血管数的增多而增加，２－３个室壁段较１个室壁段肺／心比值明显增高，肺摄取明显增加者其心肌病变范围比较广泛而严重，因此肺部～２０１ＴＬ摄取增高是冠心病患者处于高危状态的主要征象之一。结论 静息及再注射～２０１ＴＬ心肌显像是检测存活心肌较简便而无创伤性的好方法，同时也为临床提供了心肌存活方面的重要信息。Objective This study was to identify the myocardial viability and its usefulness in choosing the proper treatment, assessing the therapeutic afficacy, and predicting the prognosis. Methods 50 CAD patients were performed with rest - reinjection 201TL imaging. By comparing the first and second myocardial perfusion imaging, one can detect the viable myocardium (including stunned and hibernating myocardium). the extent of myocardial viability, and the lesion severity. Results There were 98/350(28% ) segments showed abnormal rest - blood flow perfusion in 50 CAD patients after rest 201TL myocardial imaging. Among 350 segments, 58 segments showed complete redistribution, 20 showed partial redistribution, there were 80% segments showed reversible blood flow perfusion abnormality, another 10(10% ) segments showed irreversible defects. 13 segments, showed reverse redistribution, 3 of them showed normal blood flow perfusion during rest imaging but reverse redistribution appeared after reinjection. The lwng uptake increased with the number of diseased coronary artery vessels and the lung/heart ratio in the involvement of 2 or 3 segments increased more evidently than in that of one segment. The increase of lung heart ratio suggested the focal myocardium lesions were expansive and severe. The increase lung uptake of 201TL is one of the main signs of severe CAD. Conclusions. Rest- reinjection 201TL imaging is a simple, noninvasive method in the detection of myocardium viability and it can provide clinical information regarding myocardial viability.

关 键 词：^201铊 再注射 心肌灌注 心肌存活 冠心病 

分 类 号：R817[医药卫生—影像医学与核医学]