硝酸甘油介入下^(99m)Tc MIBI心肌显像检测存活心肌

ASSESSMENT OF MYOCARDIAL VIABILITY BY TECHNETIUM- 99M SESTAMIBI TOMOGRAPHY IN COMBINATION WITH NITROGLYCERIN ADMINISTRATION

目的评价硝酸甘油（ＮＴＧ）介入下９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像在检测心肌梗死（心梗）后存活心肌中的价值。方法４８例Ｑ波型心梗病人行常规９９ｍＴｃＭＩＢＩ心肌显像（Ｒ），２４ｈ后静注示踪剂前５ｍｉｎ舌下含服ＮＴＧ（１．０ｍｇ），再行心肌显像（Ｎ），其中１２例病人作经皮腔内冠状动脉成形术（ＰＴＣＡ），术后１个月内行常规静息９９ｍＴｃＭＩＢＩ心肌显像（Ｐ）。结果Ｒ显像中１９３个灌注缺损节段，ＮＴＧ介入后有２８个节段恢复正常，２６个节段明显改善，１９个节段部分改善（Ｐ＜０．０５）。１２例行ＰＴＣＡ者术前ＮＴＧ介入后，灌注缺损得到改善的２１个节段中，术后有１６个节段得到改善，阳性预测率７６．２％，术前Ｎ显像无改善的５２个节段中，术后４２个节段无改善，阴性预测率８０．８％。结论ＮＴＧ介入后可提高９９ｍＴｃＭＩＢＩ心肌断层显像对存活心肌的检出，方便易行，安全可靠。

PURPOSE To evaluate the value of rest 99m Tc MIBI myocardial tomography under nitroglycerin (NTG) sublingual afministration in assessing myocardial viability. METHODS Routine rest 99m Tc MIBI myocardial tomogtaphy imaging was performed in 48 patients with Q wave myocardial infarction. Twenty four hours later, nitroglycerin (1.0mg) was adminstrated sublingually. 5 minutes before radionuclide injection, and then rest myocardial imaging was taken again. One month after percutaneous transluminal coronary angioplasty (PTCA) in these patients, radionuclide myocardial imaging was repeated, images were compared and analyzed. RESULTS Among 193 segments of hypoperfusion from 48 patients, administered nitroglycerin, 28 returned to normal, 26 had remarkable improvement, and 19 showed partial improvement ( P<0.05 ). of 21 segments, which showed improvement of perfusion after nitroglycerin administration, 16 had improvement after PTCA. Of 52 segments, which showed no improvement of perfusion after nitroglycerin administration, 42 had no improvement after PTCA. The positive and negative percentages of predictive accuracy after nitroglycerin intervention for myocardial viability were 76.2% and 80.8% respectively. CONCLUSIONS The administration of nitroglycerin is able to improve rest 99m Tc MIBI myocardial imaging in the detecting myocardial viability. It is a method, safe, reliable and easy to perform.