Tadamura Eiji, Mamede Marcelo, Kubo Shigeto, Toyoda Hiroshi, Yamamuro Masaki, Iida Hidehiro, Tamaki Nagara, Nishimura Kazunobu, Komeda Masashi, Konishi Junji
Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Nucl Med. 2003 May;44(5):745-51.
The use of nitrates is reported to be effective in viability detection in scintigraphic perfusion imaging. The purpose of the study was to evaluate the effect of nitroglycerin (NTG) on myocardial blood flow (MBF) and coronary vascular resistance (CVR) in various segments characterized by rest-redistribution (201)Tl SPECT.
Twenty-three patients with coronary artery disease underwent rest-redistribution (201)Tl SPECT and (15)O-labeled water PET at rest and after NTG spray (0.3 mg). In addition, 11 healthy volunteers were also studied using PET.
NTG did not change global MBF in the volunteers or in the patients. In segments with normal (201)Tl uptake and in those with a severe irreversible (201)Tl defect, NTG significantly reduced MBF without changing CVR. NTG reduced CVR in segments with a reversible (201)Tl defect (141 +/- 50 to 114 +/- 29 mm Hg/[mL/min/g], P = 0.004) and in those with a mild-to-moderate irreversible (201)Tl defect (165 +/- 64 to 149 +/- 60 mm Hg/[mL/min/g], P = 0.003), while maintaining MBF.
NTG preferentially reduces CVR in the viable myocardium with ischemia. After NTG, tracer uptake in the ischemic myocardium will be relatively increased compared with that in the nonviable and nonischemic myocardium, leading to improvements in viability detection.
据报道，硝酸盐在闪烁灌注成像的存活检测中有效。本研究的目的是评估硝酸甘油（NTG）对以静息再分布（201）Tl单光子发射计算机断层扫描（SPECT）为特征的各个节段心肌血流量（MBF）和冠状动脉血管阻力（CVR）的影响。
23例冠心病患者在静息状态下以及NTG喷雾（0.3mg）后接受静息再分布（201）Tl SPECT和（15）O标记水正电子发射断层扫描（PET）。此外，11名健康志愿者也接受了PET研究。
NTG对志愿者和患者的整体MBF没有影响。在（201）Tl摄取正常的节段以及存在严重不可逆（201）Tl缺损的节段中，NTG显著降低了MBF，而CVR未改变。NTG降低了存在可逆（201）Tl缺损节段（从141±50至114±29mmHg/[mL/min/g]；P=0.004）以及存在轻度至中度不可逆（201）Tl缺损节段（从165±64至149±60mmHg/[mL/min/g]；P=0.003）的CVR，同时维持MBF。
NTG优先降低缺血存活心肌的CVR。使用NTG后，与非存活和非缺血心肌相比，缺血心肌中的示踪剂摄取将相对增加，从而改善存活检测。
