Hatano Tsuguhisa, Chikamori Taishiro, Usui Yasuhiro, Morishima Takayuki, Hida Satoshi, Yamashina Akira
Department of Internal Medicine II, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Circ J. 2006 Feb;70(2):184-9. doi: 10.1253/circj.70.184.
There is frequently discordance in the interpretation of myocardial single-photon emission computed tomography images using both rest iodine-123 15-(p-iodophenyl)-3-(R,S) methylpentadecanoic acid (BMIPP) and stress thallium-201 ((201)Tl); that is, negative BMIPP vs positive (201)Tl studies. However, little attention has been paid to reverse discordance (ie, positive BMIPP despite negative stress (201)Tl).
In the present study 105 consecutive patients with suspected coronary artery disease (CAD) who underwent both rest BMIPP and stress (201)Tl imaging were evaluated. No patient with previous myocardial infarction was included. Scintigraphic studies revealed that BMIPP was in concordance with (201)Tl in 71 patients: both were positive in 38 and negative in 33, whereas both were discordant in 20 and reverse discordant in 14. In patients with reverse discordance, the pattern of BMIPP abnormality was segmental in 8 and spotty in 6; the former was related to coronary territory. Based on the BMIPP findings and clinical symptoms, 7 patients with positive BMIPP despite negative (201)Tl underwent coronary angiography: 3-vessel CAD was found in 3 patients, 2-vessel CAD in 1, coronary spasm in 2, and insignificant lesions in 1. In the remaining 7 patients, no cardiac event was observed during 2-year follow-up.
In patients showing positive BMIPP despite negative (201)Tl, a segmental BMIPP perfusion abnormality indicates a high likelihood for CAD, despite normal stress (201)Tl imaging. Thus, adding BMIPP to (201)Tl imaging may help to better identify patients with significant CAD, including multivessel disease.
使用静息碘 - 123 15 -（对碘苯基）- 3 -（R，S）- 甲基十五烷酸（BMIPP）和负荷铊 - 201（²⁰¹Tl）对心肌单光子发射计算机断层扫描图像进行解读时，结果常常不一致；也就是说，BMIPP结果为阴性而²⁰¹Tl结果为阳性。然而，对于相反的不一致情况（即负荷²⁰¹Tl结果为阴性但BMIPP结果为阳性）关注较少。
在本研究中，对105例连续接受静息BMIPP和负荷²⁰¹Tl成像的疑似冠状动脉疾病（CAD）患者进行了评估。未纳入有既往心肌梗死病史的患者。闪烁扫描研究显示，71例患者的BMIPP与²⁰¹Tl结果一致：38例两者均为阳性，33例两者均为阴性，而20例两者结果不一致，14例结果相反。在结果相反的患者中，BMIPP异常模式为节段性的有8例，斑点状的有6例；前者与冠状动脉供血区域相关。根据BMIPP检查结果和临床症状，7例负荷²⁰¹Tl结果为阴性但BMIPP结果为阳性的患者接受了冠状动脉造影：3例患者发现三支血管CAD，1例为两支血管CAD，2例为冠状动脉痉挛，1例为意义不大的病变。在其余7例患者中，2年随访期间未观察到心脏事件。
在负荷²⁰¹Tl结果为阴性但BMIPP结果为阳性的患者中，BMIPP灌注节段性异常表明CAD可能性高，尽管负荷²⁰¹Tl成像结果正常。因此，在²⁰¹Tl成像中加入BMIPP可能有助于更好地识别患有严重CAD的患者，包括多支血管病变患者。
