Gratz S, Raddatz D, Hagenah G, Behr T, Béhé M, Becker W
Department of Nuclear Medicine, Georg August University, Robert Koch-str 40, 37075, Göttingen, Germany.
Int J Cardiol. 2000 Aug;75(1):75-84. doi: 10.1016/s0167-5273(00)00301-6.
We performed this pilot study to gain first clinical data of immunoscintigraphy with 99mTc-labelled anti-NCA-90 antigranulocyte antibody Fab' fragments (99mTc-Fab' (LeukoScan((R)))) in endocarditis.
99mTc-Fab' and echocardiography were used in 24 consecutive patients with suspected endocarditis. Nuclear medicine imaging was performed after i.v. injection of 925 MBq 99mTc-Fab' fragments and evaluation was done by region of interest (ROI) technique and visually.
Seven patients were found to have endocarditis on the basis of the revised Duke criteria, which served as gold standard. Initial scintigraphy was true positive in five patients and false positive in one. In the five true positives, T/B ratios in projection to the heart valve plane (with T/B>/=1.3+/-0.072) were highly suspicious for florid endocarditis. TTE and TEE were true positive in two and in six patients, whereas false positives were seen in two and in four patients. Scintigraphy was positive in four of the five patients with the false negative TTE and negative in the three false positive TEE. Vice versa, TEE was positive in the two patients with false negative scintigraphy.
Immunoscintigraphy with 99mTc-Fab' fragments in combination with TEE improves diagnostic accuracy compared with TTE/TEE in patients with subacute infective endocarditis.
我们开展这项初步研究，以获取99mTc标记的抗NCA - 90抗粒细胞抗体Fab'片段（99mTc - Fab'（LeukoScan((R))））用于心内膜炎免疫闪烁显像的首批临床数据。
对24例连续的疑似心内膜炎患者使用99mTc - Fab'和超声心动图检查。静脉注射925 MBq 99mTc - Fab'片段后进行核医学成像，并通过感兴趣区（ROI）技术和视觉评估。
根据修订的杜克标准，7例患者被确诊为心内膜炎，该标准作为金标准。初始闪烁显像在5例患者中为真阳性，1例为假阳性。在5例假阳性患者中，投射至心脏瓣膜平面的T/B比值（T/B≥1.3±0.072）高度怀疑为活动性心内膜炎。经胸超声心动图（TTE）和经食管超声心动图（TEE）在2例和6例患者中为真阳性，而在2例和4例患者中出现假阳性。在TTE假阴性的5例患者中，闪烁显像有4例为阳性，在TEE假阳性的3例患者中闪烁显像为阴性。反之，在闪烁显像假阴性的2例患者中TEE为阳性。
对于亚急性感染性心内膜炎患者，与TTE/TEE相比，99mTc - Fab'片段免疫闪烁显像联合TEE可提高诊断准确性。
