Kaya Eser, Saglam Hayrettin, Ciftci Ismail, Kulac Mustafa, Karaca Semsettin, Melek Mehmet
Department of Nuclear Medicine, Faculty of Medicine, Afyon Kocatepe University, Inönü Bulvari, Afyonkarahisar, Turkey.
Ann Nucl Med. 2008 May;22(4):287-95. doi: 10.1007/s12149-007-0115-y. Epub 2008 Jun 6.
Behçet's disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system.
To determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT).
The study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS).
The mean ages of the BD and control groups were 39.3 +/- 10.6 years and 36.2 +/- 8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest WMSI. In the BD group, when gated SPECT results were compared between those with and without abnormal MPS, differences were determined in SSS, SRS, SDS, FDS, stress and rest %LV, and stress and rest WMSI. Epicardial coronary arteries were normal in CAG.
Myocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD, and CAG is frequently observed to be normal. Gated SPECT is a non-invasive reliable method that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction and the wall movements in cardio-Behçet.
白塞病（BD）是一种全身性多系统血管炎，可对心血管系统产生广泛影响。
确定白塞病中由冠状动脉微血管功能障碍引起的心肌灌注缺损的存在情况，并通过门控单光子发射计算机断层扫描（SPECT）评估冠状动脉分布和左心室收缩功能。
研究人群包括23例（15例男性和8例女性）白塞病患者和20例健康对照者（12例男性和8例女性）。采用锝-99m甲氧基异丁基异腈（Tc-99m MIBI）门控SPECT研究，在2天的方案中于负荷和静息状态下进行。计算负荷和静息状态下的左心室射血分数（LVEF）。使用非门控SPECT图像确定心肌灌注评分[负荷总分（SSS）、静息总分（SRS）、总分差（SDS）和固定缺损评分（FDS）]以及灌注缺损范围占百分比（负荷、静息缺血和固定%LV）。使用门控SPECT图像计算壁运动评分指数（负荷壁运动评分指数和静息壁运动评分指数）。对心肌灌注显像（MPS）异常的患者进行冠状动脉造影（CAG）。
白塞病组和对照组的平均年龄分别为39.3±10.6岁和36.2±8.3岁。两组在临床特征和心脏检查结果方面未观察到统计学显著差异。13例（56.5%）白塞病患者存在MPS异常；3例患者有非透壁梗死，10例患者有可逆性灌注缺损。2例对照者（10.0%）也发现有可逆性灌注缺损。当比较两组的门控SPECT结果时，在以下参数中确定了差异；SSS、SRS、SDS、FDS、负荷和静息LVEF、负荷和静息%LV以及负荷和静息WMSI。在白塞病组中，比较有和没有MPS异常者的门控SPECT结果时，在SSS、SRS、SDS、FDS、负荷和静息%LV以及负荷和静息WMSI方面确定了差异。CAG显示心外膜冠状动脉正常。
白塞病中由于冠状动脉微血管受影响，心肌灌注和功能受到干扰，且经常观察到CAG正常。门控SPECT是一种非侵入性可靠方法，可同时评估心脏白塞病中心肌缺血或梗死的存在、范围和严重程度以及壁运动情况。
