Omür Ozgür, Ozcan Zehra, Argon Murat, Acar Ebru Tani
Department of Nuclear Medicine, Ege University Medical Faculty, Bornova-Izmir, Turkey.
Int J Cardiovasc Imaging. 2008 Feb;24(2):173-81. doi: 10.1007/s10554-007-9244-6. Epub 2007 Jun 19.
Myocardial perfusion scintigraphy (MPS) is an effective tool for early diagnosis of coronary artery disease (CAD) in type II diabetes mellitus (DM). The purpose of this study was to review the comparative findings of Tc-99m MIBI and Tl-201 MPS in defining normal and abnormal myocardial segments, type and extent of the perfusion defects with reference to coronary angiography findings in diabetic patients.
Thirty patients with type II DM who had abnormal Tc-99m MIBI MPS findings and underwent coronary angiography were included this study (20 male, 10 female; mean age was 64 +/- 11 years). Those patients were also investigated with Tl-201 MPS thereafter. All scintigraphic images were evaluated semiquantitatively using a 20-segments myocardial model. The perfusion of myocardial segments, reversibility and severity of defects based on defect score were compared using the MIBI and Tl-201 images in relation to coronary angiography. Diffuse slow-washout of Tl-201 was also noted.
A total of 600 myocardial segments were comparatively analyzed. Diagnostic concordance between both tracers in defining normal and abnormal perfusion on a segmental basis was 88% (kappa = 0.71). The percentage of normal, reversible and non-reversible segments in the Tc-99m MIBI and Tl-201 study were 67-61%, 11-20% and 22-19% respectively. While the number of irreversible defects were similar for both tracers, more number of reversible defects were identified by Tl-201 MPS than Tc-99m MIBI (65 vs. 123, p = 0.001). No significant difference between the defect scores of both tracers was found.
MPS using both tracers offered agreement in defining or excluding perfusion abnormalities in a major part of the data. However, Tl-201 MPS yielded better detection rate of myocardial ischemia than Tc-99m MIBI MPS in diabetic patients.
心肌灌注显像（MPS）是早期诊断2型糖尿病（DM）患者冠状动脉疾病（CAD）的有效工具。本研究的目的是参照糖尿病患者的冠状动脉造影结果，回顾锝-99m甲氧基异丁基异腈（Tc-99m MIBI）和铊-201（Tl-201）心肌灌注显像在定义正常和异常心肌节段、灌注缺损的类型和范围方面的对比结果。
本研究纳入了30例Tc-99m MIBI心肌灌注显像结果异常且接受了冠状动脉造影的2型糖尿病患者（20例男性，10例女性；平均年龄64±11岁）。此后，这些患者也接受了Tl-201心肌灌注显像检查。所有闪烁显像图像均使用20节段心肌模型进行半定量评估。基于缺损评分，比较MIBI和Tl-201图像在心肌节段灌注、缺损的可逆性和严重程度方面与冠状动脉造影的关系。还记录了Tl-201的弥漫性缓慢洗脱情况。
共对600个心肌节段进行了对比分析。两种示踪剂在节段基础上定义正常和异常灌注的诊断一致性为88%（kappa = 0.71）。Tc-99m MIBI和Tl-201研究中正常、可逆和不可逆节段的百分比分别为67%-61%、11%-20%和22%-19%。虽然两种示踪剂的不可逆缺损数量相似，但Tl-201心肌灌注显像发现的可逆缺损数量多于Tc-99m MIBI（65对123，p = 0.001）。两种示踪剂的缺损评分之间未发现显著差异。
使用两种示踪剂的心肌灌注显像在大部分数据中对于定义或排除灌注异常具有一致性。然而，在糖尿病患者中，Tl-201心肌灌注显像对心肌缺血的检测率优于Tc-99m MIBI心肌灌注显像。
