DePuey E G
J Nucl Med. 1991 Aug;32(8):1564-8.
The substitution of intravenous dipyridamole for symptom-limited treadmill exercise has provided a non-invasive means to diagnose coronary artery disease with 201Tl scintigraphy in patients unable to adequately exercise. Limitations of dipyridamole/thallium imaging are primarily due to suboptimal image quality secondary to hepatic tracer concentration and decreased test sensitivity in patients who are dipyridamole "non-responders." Low-level treadmill exercise supplementation improves image quality, whereas handgrip has little, if any, benefit. The effect of low-level exercise in augmenting coronary blood flow is unknown and reports regarding the effect of handgrip are conflicting. The diagnostic benefit of these maneuvers in improving test sensitivity and decreasing the number of "non-responders" has not been documented. The combination of maximal, symptom-limited treadmill exercise and intravenous dipyridamole is a theoretically attractive option to improve overall test sensitivity, but the physiologic consequences and potential side effects should be more thoroughly investigated.
对于无法充分运动的患者，用静脉注射双嘧达莫替代症状限制性平板运动，为通过201Tl闪烁扫描术诊断冠状动脉疾病提供了一种非侵入性方法。双嘧达莫/铊显像的局限性主要是由于肝脏示踪剂浓度导致图像质量欠佳，以及在双嘧达莫“无反应者”中测试敏感性降低。低水平平板运动补充可改善图像质量，而握力运动即使有好处也微乎其微。低水平运动增加冠状动脉血流的作用尚不清楚，关于握力运动作用的报道相互矛盾。这些操作在提高测试敏感性和减少“无反应者”数量方面的诊断益处尚未得到证实。最大症状限制性平板运动与静脉注射双嘧达莫相结合，在理论上是提高总体测试敏感性的一个有吸引力的选择，但生理后果和潜在副作用应进行更深入的研究。
