双核素门控心肌断层显像对心肌缺血的诊断价值

A clinical study of gated simultaneous rest ~ (201)Tl/stress ~ (99)Tc^m-sestamibi dual isotope myocardial perfusion imaging

目的 提高心肌断层显像技术对冠心病诊断的准确性和实用性。方法 采用双核素门控心肌断层显像对 10 3例受检者进行检查 ,患者分为冠心病组 (3 7例 )和非冠心病组 (66例 )。静息注射2 0 1Tl和运动高峰注入99Tcm 甲氧基异丁基异腈 (MIBI) ,40min后一次性进行门控双能峰断层采集。分析比较运动和静息的断层图像 ,以及室壁运动、心肌灌注、室壁增厚度和区域射血分数值等 4个功能图像和左室功能参数 :左室射血分数、舒张末期容积和收缩末期容积 (LVEF、EDV和ESV) ,并以不同角度的“双网图”分析各心壁运动情况。有 3 8例在 2周内进行冠状动脉造影。结果 冠心病组检查阳性 94.6% (3 5 / 3 7例 ) ,阴性 5 .4% (2 / 3 7例 ) ;非冠心病组中检查阳性 10 .6% (7/ 66例 ) ,阴性89.4% (5 9/ 66例 )。冠心病组中双核素门控心肌断层显像提示心肌缺血共 48个节段 ,其中有 3 2个在功能图像上出现室壁运动下降和 (或 )区域LVEF值降低 (66.7% )。冠心病组LVEF(% ) ,EDV(mL)和ESV(mL)分别为 5 2 .3 3± 16.2 6,70 .45± 2 8.12和 3 3 .3 5± 18.86,非冠心病组分别为 61.76± 9.3 8,60 .45± 18.18和 2 3 .3 0± 11.0 9,两组之间比较P <0 .0 1(t=2 .96) ,P <0 .0 5 (t =2 .5 5 ) ,P <0 .0 5 (t =2 .67)。其中 3 8例与冠状?

Objective To investigate a modified gated radionuclide myocardial tomography in methodology for raising the sensitivity and efficiency of detecting myocardial ischemia. Methods One hundred and three patients were involved and divided into two groups: coronary artery disease (CAD) patient 37, non-CAD patient 66. ~ 201Tl 111 MBq was injected intravenously 5 min before stress, the patient exercised with ergometer following the modified Bruce protocol, and was injected ~ 99Tc^m-sestamibi at the peak of stress. 45 min later, the simultaneous dual energy peak gated acquisition was then performed. Stress (~ 99Tc^m-sestamibi) and rest(~ 201Tl) images were reconstructed. Results Positive findings were seen in 35/37 (94.6%) in CAD group and 7/66 (10.6%) in non-CAD, respectively; LVEF, EDV and ESV of two groups were (52.33±16.26)%, (70.45±28.12) mL, (33.35±18.86) mL and (61.76±9.38)%, (60.45±18.18) mL, (23.30±11.09) mL, respectively. Conclusion The simultaneous stress (~ 99Tc^m-sestamibi) and rest(~ 201Tl )gated myocardial imaging is an efficient and practical protocol for the study of myocardial perfusion and the diagnosis of ischemia.