Manrique A, Faraggi M, Eltchaninoff H, Cribier A, Le Guludec D, Véra P
GIE et service de médecine nucléaire, CHU et centre Henri-Beçquerel, 1, rue d'Amiens, 76000 Rouen.
Arch Mal Coeur Vaiss. 2001 Feb;94(2):118-23.
Electrocardiographic gated myocardial scintigraphy (gated SPECT) allows simultaneous evaluation of left ventricular perfusion and contractility. The aim of this study was to assess the impact of the type of tracer and temporal sampling on the measurement of the ejection fraction by gated SPECT. Eighty-six consecutive patients (59 men, 27 women, average age 62 +/- 11 years) with a history of myocardial infarction (anterior N = 50--inferior N = 36) were studied. All had measurement of the isotopic ejection fraction by equilibrium angioscintigraphy and by gated SPECT sampled at 8 (N = 45, 52%) or 16 images/cycle RR (N = 41, 48%). After filtered retroprojection, the ejection fraction was calculated by a validated method (QGS). A better correlation between gated SPECT and equilibrium angioscintigraphy was observed at 16 images/cycle (r = 0.90) compared with 8 (r = 0.80). The Bland-Altman curves showed improved accuracy of the measurement of the ejection fraction by gated SPECT with 16 compared with 8 images/cycles sampling (mean differences of 0.37 +/- 6.06% and 4.3 +/- 7.71%, respectively). Multivariable analysis showed that temporary sampling was the only parameter to significantly affect the difference between the two methods. There was no difference between the use of Thallium and that of 99mTc-sestamibi. Gated SPECT, therefore, provides an accurate measurement of the ejection fraction for routine clinical usage, providing the acquisition is made at 16 images/cycle.
心电图门控心肌闪烁显像（门控单光子发射计算机断层扫描）可同时评估左心室灌注和收缩功能。本研究的目的是评估示踪剂类型和时间采样对门控单光子发射计算机断层扫描测量射血分数的影响。对86例连续的有心肌梗死病史的患者（59例男性，27例女性，平均年龄62±11岁）进行了研究，其中前壁心肌梗死50例，下壁心肌梗死36例。所有患者均通过平衡心血池闪烁显像和门控单光子发射计算机断层扫描测量同位素射血分数，门控单光子发射计算机断层扫描以每心动周期RR间期采集8帧图像（45例，52%）或16帧图像（41例，48%）。经滤波反投影后，采用经验证的方法（QGS）计算射血分数。与每心动周期采集8帧图像（r = 0.80）相比，每心动周期采集16帧图像时，门控单光子发射计算机断层扫描与平衡心血池闪烁显像之间的相关性更好（r = 0.90）。Bland-Altman曲线显示，每心动周期采集16帧图像时门控单光子发射计算机断层扫描测量射血分数的准确性高于采集8帧图像时（平均差异分别为0.37±6.06%和4.3±7.71%）。多变量分析显示，时间采样是显著影响两种方法差异的唯一参数。使用铊和使用99m锝-甲氧基异丁基异腈之间没有差异。因此，门控单光子发射计算机断层扫描可为常规临床应用提供准确的射血分数测量值，前提是每心动周期采集16帧图像。
