Matsuo H, Watanabe S, Arai M, Kotoo Y, Oohashi H, Oda H, Ueno K, Matsubara T, Ohno M, Mori S
Department of Cardiology and Nephrology, Gifu Prefectural Hospital.
Kaku Igaku. 1991 May;28(5):477-85.
To assess the diagnostic value of Tc-99m PYP, Tl-201 dual isotope SPECT for the evaluation of myocardial viability, segmental comparison between dual isotope SPECT and exercise, delayed, and reinjected Tl study were performed with 18 AMI patients. Among 72 damaged myocardial segments, 48 segments (67%) were judged as viable by chronic phase Tl studies. The segments with severely reduced Tl uptake by dual SPECT showed significantly lower prevalence of viable myocardium than the segments with reduced and normal Tl uptake (p less than 0.001). The segments with PYP accumulation localized to the subendocardium represented the favorable outcome compared with the transmural accumulation (p less than 0.001). And overlap segments show better prognosis than the segments without overlap (p less than 0.05). Most importantly, we can get better predictive accuracy of myocardial scar by dual isotope SPECT than the judgement by Tl or PYP SPECT alone (83.3% vs 77.8%, 68.1%). Thus, we conclude that Tc-99m PYP, Tl-201 dual isotope SPECT is useful to assess the severity of myocardial damage in the acute phase of myocardial infarction.
为评估锝-99m焦磷酸钠（Tc-99m PYP）、铊-201（Tl-201）双核素单光子发射计算机断层扫描（SPECT）对评估心肌存活性的诊断价值，对18例急性心肌梗死（AMI）患者进行了双核素SPECT与运动试验、延迟及再注射铊显像的节段性比较。在72个受损心肌节段中，48个节段（67%）经慢性期铊显像判断为存活。双核素SPECT显示铊摄取严重降低的节段，其存活心肌的患病率显著低于铊摄取降低和正常的节段（p<0.001）。与透壁性积聚相比，心内膜下有PYP积聚的节段预后较好（p<0.001）。重叠节段的预后优于无重叠节段（p<0.05）。最重要的是，与单独使用铊或PYP SPECT判断相比，双核素SPECT对心肌瘢痕的预测准确性更高（83.3%对77.8%、68.1%）。因此，我们得出结论，Tc-99m PYP、Tl-201双核素SPECT有助于评估心肌梗死急性期心肌损伤的严重程度。
