Berman Daniel S, Kang Xingping, Tamarappoo Balaji, Wolak Arik, Hayes Sean W, Nakazato Ryo, Thomson Louise E J, Kite Faith, Cohen Ishac, Slomka Piotr J, Einstein Andrew J, Friedman John D
Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
JACC Cardiovasc Imaging. 2009 Mar;2(3):273-82. doi: 10.1016/j.jcmg.2008.12.012.
Our purpose was to describe a novel, rapid stress thallium-201 (Tl-201)/rest technetium-99m (Tc-99m) agent myocardial perfusion imaging (MPI) protocol (Tl/Tc) with a high-speed MPI scanner and to compare this protocol with a standard rest/stress Tc-99m agent protocol (Tc/Tc) with respect to image quality and radiation dosimetry.
Recent advances in gamma camera technology have provided opportunity for improved SPECT MPI protocols. A rapid Tl/Tc protocol that could improve image information while maintaining a low radiation burden for the patient would be desirable.
We compared high-speed SPECT MPI studies in 374 consecutive patients undergoing exercise or pharmacologic Tl/Tc protocol to those of 262 patients undergoing rest/stress Tc/Tc protocol.
Tl/Tc imaging was accomplished in <20 min. Overall image quality was good to excellent in 96% and 98% of patients with the Tl/Tc and the Tc/Tc protocols, respectively (p = ns). Beginning rest imaging within 2 min after rest injection with the Tl/Tc protocol did not result in reduced confidence in image interpretation. Early rest Tc images of the Tl/Tc protocol showed less extracardiac activity than was observed on standard rest imaging used in the Tc/Tc protocol (84% vs. 61%), respectively (p < 0.01). The normalcy rate was high in both groups (100% vs. 92%). Radiation burden was similar between the Tl/Tc and Tc/Tc protocols.
A rapid stress Tl-201/rest Tc-99m protocol for use with high-speed SPECT MPI has image quality and radiation dosimetry similar to those observed with a conventional rest/stress Tc-99m protocol. The Tl/Tc protocol offers promise as an efficient and relatively low radiation dose method, in which the superior qualities of Tl-201 for stress imaging and of the Tc-99m agents for rest imaging can be preserved. The findings also suggest that with rapid imaging rest MPI immediately after Tc-99m agent injection may be superior to standard delayed image initiation.
我们的目的是描述一种使用高速心肌灌注成像（MPI）扫描仪的新型、快速的应激铊-201（Tl-201）/静息锝-99m（Tc-99m）剂心肌灌注成像（MPI）方案（Tl/Tc），并在图像质量和辐射剂量测定方面将该方案与标准的静息/应激Tc-99m剂方案（Tc/Tc）进行比较。
γ相机技术的最新进展为改进单光子发射计算机断层扫描（SPECT）MPI方案提供了机会。一种能够在为患者维持低辐射负担的同时改善图像信息的快速Tl/Tc方案将是理想的。
我们将374例连续接受运动或药物性Tl/Tc方案的患者的高速SPECT MPI研究与262例接受静息/应激Tc/Tc方案的患者的研究进行了比较。
Tl/Tc成像在20分钟内完成。分别有96%和98%的采用Tl/Tc和Tc/Tc方案的患者总体图像质量良好至优秀（p=无显著性差异）。采用Tl/Tc方案在静息注射后2分钟内开始静息成像并未导致图像解读可信度降低。Tl/Tc方案的早期静息Tc图像显示心外活动比Tc/Tc方案中使用的标准静息成像观察到的少（分别为84%对61%）（p<0.01）。两组的正常率都很高（100%对92%）。Tl/Tc和Tc/Tc方案之间的辐射负担相似。
一种用于高速SPECT MPI的快速应激Tl-201/静息Tc-99m方案的图像质量和辐射剂量测定与传统的静息/应激Tc-99m方案相似。Tl/Tc方案有望成为一种高效且辐射剂量相对较低的方法，其中可以保留Tl-201用于应激成像和Tc-99m剂用于静息成像的优越特性。研究结果还表明，在注射Tc-99m剂后立即进行快速成像静息MPI可能优于标准的延迟图像启动。
