负荷心肌灌注显像中铊-201门控单光子发射计算机断层心肌灌注显像的心肌短暂性缺血性顿抑：心肌灌注、室壁运动及室壁增厚变化的节段性分析

Transient ischemic stunning of the myocardium in stress thallium-201 gated SPET myocardial perfusion imaging: segmental analysis of myocardial perfusion, wall motion and wall thickening changes.

作者信息

Santiago Jonas Francisco Y, Heiba Sherif I, Jana Suman, Mirzaitehrane Majid, Dede Fuat, Abdel-Dayem Hussein M

机构信息

Nuclear Medecine Service, Department of Radiology, St. Vincent's Catholic Medical Centers of New York, 153 West 11 Street, New York, NY 10011, USA.

出版信息

Eur J Nucl Med Mol Imaging. 2002 Aug;29(8):979-83. doi: 10.1007/s00259-002-0824-3. Epub 2002 May 17.

DOI:10.1007/s00259-002-0824-3

PMID:12173009

Abstract

Prolonged and persistent myocardial stunning has recently been demonstrated using technetium-99m sestamibi gated single-photon emission tomography (SPET) myocardial perfusion imaging post exercise or pharmacological stress test. In this study, we investigated the early postischemic transient myocardial stunning on early and delayed poststress thallium-201 gated SPET myocardial perfusion imaging using segmental wall motion (WM) and wall thickening (WT) analysis. A total of 1,680 segments from 84 patients' studies (53 men and 31 women, mean age 60 years) were evaluated on both early and delayed thallium-201 gated SPET treadmill exercise (59) or dobutamine stress (25) myocardial perfusion imaging. Semiquantitative analysis of perfusion, WM and WT in all segments was performed by two observers. Segments were classified according to changes in WM and WT between early and delayed images into normal, fixed abnormality, or improved abnormality (transient stunning), and were further classified according to changes in perfusion into normal, fixed defects, or ischemic. There were significant correlations between perfusion and WM, perfusion and WT, and WM and WT segmental scores on both early and delayed images. Transient stunning was seen significantly ( P < 0.001) more often in ischemic segments than were normal or fixed perfusion defects using WM (58%) and WT (50%) assessments. There was also a significant correlation between the severity of ischemia and transient stunning with either WM ( P < 0.05) or WT ( P < 0.005) evaluation. Segmental myocardial contractility assessment from gated SPET (201)Tl myocardial perfusion imaging using WM and WT was comparable, and results correlated well with the myocardial perfusion assessment. Early transient myocardial stunning was frequently observed in ischemic segments and was related to the severity of myocardial ischemia.

摘要

最近通过锝-99m 甲氧基异丁基异腈门控单光子发射断层扫描（SPET）心肌灌注成像在运动或药物负荷试验后证实了存在长期持续性心肌顿抑。在本研究中，我们使用节段性室壁运动（WM）和室壁增厚（WT）分析，通过早期和延迟负荷后铊-201 门控 SPET 心肌灌注成像，研究了缺血后早期短暂性心肌顿抑情况。对 84 例患者（53 名男性和 31 名女性，平均年龄 60 岁）的研究中的总共 1680 个节段进行了早期和延迟铊-201 门控 SPET 平板运动（59 例）或多巴酚丁胺负荷（25 例）心肌灌注成像评估。两名观察者对所有节段的灌注、WM 和 WT 进行了半定量分析。根据早期和延迟图像之间 WM 和 WT 的变化，将节段分为正常、固定异常或改善异常（短暂性顿抑），并根据灌注变化进一步分为正常、固定缺损或缺血。早期和延迟图像上灌注与 WM、灌注与 WT 以及 WM 和 WT 节段评分之间均存在显著相关性。使用 WM（58%）和 WT（50%）评估时，缺血节段出现短暂性顿抑的情况明显（P<0.001）多于正常或固定灌注缺损节段。缺血严重程度与使用 WM（P<0.05）或 WT（P<0.005）评估的短暂性顿抑之间也存在显著相关性。使用 WM 和 WT 通过门控 SPET（201）Tl 心肌灌注成像进行的节段性心肌收缩力评估具有可比性，结果与心肌灌注评估相关性良好。早期短暂性心肌顿抑在缺血节段中经常观察到，并且与心肌缺血的严重程度相关。