双核素显像在评价AMI患者心肌灌注与活力中的应用

Application of Dual-isotope Imaging in Evaluating Myocardial Metabolism and Perfusion of Patients with AMI

目的探讨201Tl、99Tcm-HL91双核素心肌显像与18F-FDG显像结合99Tcm-MIBI心肌显像在评价急性心肌梗死(AMI)患者心肌代谢及血流灌注中的临床应用价值。方法 对10例AMI患者行10 min和3 h 201Tl与99Tcm-HL91双核素心肌显像,采用17节段分析法来评价201TI显像节段性稀疏缺损与乏氧节段性显影;对25例AMI患者在PCI术后2周行18F-FDG心肌代谢显像及99Tcm-MIBI静息心肌显像,行圆周剖面半定量分析评价局部心肌灌注、代谢与室壁运动功能之间的关系。结果 (1)75％(21／28)的201Tl灌注缺损心肌节段在乏氧显像中该节段显影,提示有存活心肌,7个不显影节段均为下壁节段,99Tcm-HL91显影节段数明显大于201Tl灌注缺损区。(2)AMI患者术后2周心肌运动正常节段(n=284)99Tcm-MIBI％、18F-FDG％分别为83.71％±15.67％和89.40％±13.62％,高于运动减弱组(n=51)的68.45％±17.34％和71.19％±18.56％,高于无运动组(n=65)的32.26％±14.91％和56.08％±18.83％,运动减弱组高于无运动组,3组间差异有统计学意义(P<0.01)。室壁运动评分指数(WMSI)与99Tcm-MIBI缺损百分率呈正相关(r=0.791,P<0.05)。结论201Tl、99Tcm-HL91双核素心肌显像与18F-FDG显像结合99Tcm-MIBI心肌显像均可用于临床判断AMI患者的存活心肌及血流灌注。

Objective To investigate the clinic value of 201 Tl and 99Tcm-HL91 dual-isotope imaging and 18F-FDG, 99Tcm-MIBI combined with SPECT imaging in assessing myocardial glucose metabolism and perfusion in patients with AMI. Methods Ten patients with AMI undergoing 201T1 and 99Tcm-HL91 dual-isotope imaging. A 17-segment model was used to assess the defect on myocardial perfusion images and the hot spot on myocardial hypoxic images. Twenty five patients with AMI undergoing 18F-FDG SPECT glucose metabolic imaging and 99Tcm-MIBI imaging at 2 weeks after PCI, and resting echocardiography 3 months after PCI. Circumferential count profiles from18F-FDG and Tcm-MIBI short axis slices were generated to assess myocardial regional blood flow and glucose metabolism. Results (1) 75% (21/28) of myocardial segments showing cold defects on 201T1 imaging of patients with AMI showed 'hot spot' on 99Tcm-HL91 imaging. The number of myocardial segments which showed 'hot spot' on 99Tcm-HL91 imaging was more than that which showed cold defects on 201T1 imaging. The uptake of 99Tcm-MIBI in normal, hypokines and akinesia segments was83.71±15.67, 68.45±17.34, and 32. 26±14.91, respectively.The uptake of 18F-FDG in normal, hypokines and akinesia segments was 89.40±13.62,71.19±18. 56, and 56.08±18.83. There was significant difference among three groups (P<0.01). The defect value of 99Tcm-MIBIcorrelated with WMSI (r=0.791, P<0.05) . Conclusion 201 Tl and 99Tcm-HL91 dual-isotope imaging and 18F-FDG, 99Tcm-MIBI combined with SPECT imaging can be used in clinic to evaluate myocardial glucose metabolism and perf usion of the patients with AMI after PCI.