Goel Sumina, Bommireddipalli Srinivas, DePuey E Gordon
Division of Nuclear Medicine, Department of Radiology, St Luke's-Roosevelt Hospital, and Columbia University College of Physicians and Surgeons, New York, New York, USA.
J Nucl Med Technol. 2009 Dec;37(4):240-3. doi: 10.2967/jnmt.109.065847. Epub 2009 Nov 13.
On the basis of previously unpublished observations, we hypothesized that prolonged use of proton pump inhibitors (PPIs) causes an increase in (99m)Tc-sestamibi uptake in the stomach wall, manifested as curvilinear activity surrounding the photopenic fundus of the stomach cavity. We prospectively evaluated the frequency of stomach wall uptake in patients undergoing myocardial perfusion SPECT who were taking PPIs or H(2) antagonists.
Patients (n = 138) who were scheduled for single-day rest/stress (99m)Tc-sestamibi SPECT were randomly selected. Poststress SPECT was performed 30 min after treadmill exercise or 45 min after dipyridamole infusion. The rest scan was obtained 45 min after tracer injection. All patients drank 473 mL of water 5-10 min after both the rest and the stress radiotracer injections. Patients were questioned regarding their use of PPIs and H(2) antagonists. The significant use of either was defined as more than 2 wk of continuous therapy before cardiac SPECT. Masked observers assessed poststress planar projection images in endless-loop cinematic format for the following 3 patterns: stomach cavity uptake, attributable to duodenogastric reflux of tracer; stomach wall uptake; and no stomach uptake. A 2-tailed chi(2) test with Yates correction was used to calculate statistically significant associations among variables.
Only patients with observed patterns of stomach wall uptake (n = 30) and no stomach wall uptake (n = 91) were included. Patients with stomach cavity uptake (n = 17) were excluded because the assessment of the adjacent stomach wall uptake was not possible. Of the patients included (n = 121), 30 were men and 91 were women. Sixty-seven patients were older than 60 y; 26 patients were taking PPIs. Of the 95 patients not taking PPIs, 14 were taking H(2) antagonists. No patients were taking both medications. Stomach wall uptake was strongly associated with prolonged use of PPIs (chi(2) = 51.9, P < 0.0001). No statistically significant association was noted among age, sex, or use of H(2) antagonists (P = NS).
Prolonged PPI therapy, but not H(2) antagonist therapy, contributes to a significant increase in stomach wall activity, potentially resulting in Compton scatter or ramp filter artifacts affecting the inferior wall of the left ventricle. Stomach wall activity, unlike the stomach cavity activity, cannot be prevented by the ingestion of water before imaging. Therefore, it is important to elicit a history of prolonged PPI use to better anticipate the possibility of increased stomach wall activity, which can confound the image quality and interpretation.
基于此前未发表的观察结果，我们推测长期使用质子泵抑制剂（PPI）会导致胃壁对锝-99m 甲氧基异丁基异腈（99mTc-sestamibi）摄取增加，表现为胃腔放射性缺损的胃底周围呈曲线状放射性浓聚。我们前瞻性评估了服用 PPI 或 H2 拮抗剂的心肌灌注单光子发射计算机断层扫描（SPECT）患者胃壁摄取的频率。
随机选择计划进行单日静息/负荷 99mTc-sestamibi SPECT 的患者（n = 138）。在跑步机运动后 30 分钟或双嘧达莫输注后 45 分钟进行负荷 SPECT。在注射示踪剂后 45 分钟进行静息扫描。所有患者在静息和负荷放射性示踪剂注射后 5 - 10 分钟饮用 473 mL 水。询问患者关于 PPI 和 H2 拮抗剂的使用情况。两者的显著使用定义为心脏 SPECT 前连续治疗超过 2 周。盲法观察者以无限循环电影格式评估负荷平面投影图像的以下 3 种模式：胃腔摄取，归因于示踪剂的十二指肠-胃反流；胃壁摄取；以及无胃摄取。使用带有 Yates 校正的双侧卡方检验计算变量之间的统计学显著关联。
仅纳入观察到胃壁摄取模式的患者（n = 30）和无胃壁摄取的患者（n = 91）。排除胃腔摄取的患者（n = 17），因为无法评估相邻胃壁摄取情况。纳入的患者（n = 121）中，30 例为男性，91 例为女性。67 例患者年龄大于 60 岁；26 例患者服用 PPI。在未服用 PPI 的 95 例患者中，14 例服用 H2 拮抗剂。没有患者同时服用这两种药物。胃壁摄取与长期使用 PPI 密切相关（卡方 = 51.9，P < 0.0001）。在年龄、性别或 H2 拮抗剂使用方面未观察到统计学显著关联（P = 无显著性差异）。
长期 PPI 治疗而非 H2 拮抗剂治疗会导致胃壁放射性显著增加，可能导致康普顿散射或斜坡滤波伪影影响左心室下壁。与胃腔放射性不同，胃壁放射性不能通过成像前饮水来预防。因此，了解长期使用 PPI 的病史很重要，以便更好地预测胃壁放射性增加的可能性，这可能会混淆图像质量和解读。
