Haubold-Reuter B, Haldemann R, Amann F, Turina J, Reist W, Leenders K, von Schulthess G K
Department of medizinische Radiologie, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1992 Jan 8;122(1-2):14-21.
Nuclear cardiology, and in particular myocardial scintigraphy, is used with increasing frequency to detect the presence of ischemia before revascularization by angioplasty or coronary artery bypass grafting. On the basis of recent publications it is evident that there are certain conditions in which conventional diagnostic methods suggest the presence of myocardial necrosis, but there is persistent metabolically active myocardial tissue. One of these conditions is the "hibernating myocardium". Patients with this disease entity will show an improvement in cardiac function after revascularization in over 85% cases. Therefore, the diagnosis of "hibernating myocardium" has a high predictive value. Differentiation between irreversible myocardial necrosis and "hibernating myocardium" is possible by positron emission tomography (PET) combining imaging of myocardial metabolism with imaging of myocardial perfusion. With 30 months, 36 patients with established myocardial infarction and a suspicion of "hibernating myocardium" have been examined in the PET scanner at the Paul Scherrer Institute, Villigen. Images of glucose metabolism were obtained by 18-fluoro-deoxyglucose and perfusion images were obtained using thallium in a first phase (thallium-SPECT at rest) and rubidium-82) as a positron emitter in second phase. We were able to identify patterns that suggest the presence of "hibernating myocardium", in 19 of 36 patients (53%). The basic principles and limitations of myocardial positron emission tomography are discussed.
核心脏病学，尤其是心肌闪烁显像术，在血管成形术或冠状动脉搭桥术进行血运重建之前，用于检测心肌缺血的频率越来越高。根据最近的出版物，很明显在某些情况下，传统诊断方法提示存在心肌坏死，但仍存在代谢活跃的心肌组织。其中一种情况就是“冬眠心肌”。患有这种疾病实体的患者在血运重建后，超过85%的病例心脏功能会有所改善。因此，“冬眠心肌”的诊断具有很高的预测价值。通过将心肌代谢成像与心肌灌注成像相结合的正电子发射断层扫描（PET），可以区分不可逆心肌坏死和“冬眠心肌”。在30个月的时间里，36例确诊心肌梗死且疑似“冬眠心肌”的患者在位于维利根的保罗·谢尔研究所的PET扫描仪上接受了检查。通过18-氟脱氧葡萄糖获得葡萄糖代谢图像，并在第一阶段使用铊（静息铊单光子发射计算机断层扫描），在第二阶段使用作为正电子发射体的铷-82获得灌注图像。我们能够在36例患者中的19例（53%）中识别出提示“冬眠心肌”存在的模式。本文讨论了心肌正电子发射断层扫描的基本原理和局限性。
