采用门控单光子发射计算机断层扫描术，利用锝-99m甲氧基异丁基异腈评估重症先天性心脏病儿童及青少年的心肌灌注和功能。

Evaluation of myocardial perfusion and function by gated single-photon emission computed tomography technetium-99m methoxyisobutylisonitrile in children and adolescents with severe congenital heart disease.

作者信息

Sobic-Saranovic Dragana P, Pavlovic Smiljana V, Jovanovic Ida V, Stefanovic Igor D, Artiko Vera M, Djukic Milan M, Obradovic Vladimir B

机构信息

Institute for Nuclear Medicine, Clinical Center of Serbia, Belgrade, Serbia.

出版信息

Nucl Med Commun. 2010 Jan;31(1):12-21. doi: 10.1097/MNM.0b013e3283295622.

DOI:10.1097/MNM.0b013e3283295622

PMID:19952920

Abstract

OBJECTIVES

The value of gated single-photon emission computed tomography technetium-99m methoxyisobutylisonitrile (gated SPECT (99m)Tc-MIBI) in children is not yet established probably because gated SPECT (99m)Tc-MIBI has rarely been used in pediatric clinical and research studies. The purpose of this study was to evaluate perfusion abnormalities and left ventricular (LV) function by gated SPECT (99m)Tc-MIBI in children and adolescents with severe congenital heart disease (CHD).

METHODS

Seventeen children and adolescents with severe CHD (11 boys and six girls, mean age 11+/-4 years) underwent 2-day rest-stress (11 boys) or 1-day rest (six girls) gated SPECT (99m)Tc-MIBI. Myocardial perfusion was evaluated by a 17-segment model with a 5-point score to derive the summed stress score, the summed rest score (SRS), and the summed difference score based on the 4D-MSPECT software results. The extent of myocardial perfusion abnormalities was also expressed as a percentage of the LV size. The 4D-MSPECT software was used to calculate LV end-diastolic volume, end-systolic volume (ESV), and ejection fraction (EF).

RESULTS

Reversible myocardial perfusion defect was found in 7 of 11 children (64%) who underwent rest-stress gated SPECT (99m)Tc-MIBI. The LV segments involved were anterior, anteroseptal, anterolateral, apical and inferior. These seven children showed significantly larger perfusion abnormalities on stress compared with rest study (18+/-5 vs. 7+/-4%, P<0.01) and higher summed stress score compared to SRS (11+/-4 vs. 4+/-2, P<0.01). Children and adolescents with myocardial ischemia had significantly lower poststress EF than rest EF (53+/-12 vs. 59+/-11%, P<0.05) and significantly higher poststress ESV than rest ESV (81+/-24 vs. 61+/-25 ml, P<0.05). In six children evaluated only at rest, perfusion defects involved anterior, anteroseptal and apical, or inferolateral segments, accounting for 31+/-12% of LV and with SRS of 12+/-5. Their global LV parameters were: end-diastolic volume 118+/-23 ml, ESV 56+/-16 ml, EF 51+/-10%.

CONCLUSION

Poststress and rest-gated SPECT (99m)Tc-MIBI results indicate that children and adolescents with severe CHD show a range of abnormalities in myocardial perfusion and LV function, which is useful for determining functional importance of morphological malformations. Thus, gated SPECT (99m)Tc-MIBI provides complementary information that may guide clinical decision making in children and adolescents with severe CHD.

摘要

目的

门控单光子发射计算机断层扫描99m锝甲氧基异丁基异腈（门控SPECT（99m）Tc-MIBI）在儿童中的价值尚未确定，可能是因为门控SPECT（99m）Tc-MIBI在儿科临床和研究中很少使用。本研究的目的是通过门控SPECT（99m）Tc-MIBI评估患有严重先天性心脏病（CHD）的儿童和青少年的灌注异常及左心室（LV）功能。

方法

17例患有严重CHD的儿童和青少年（11名男孩和6名女孩，平均年龄11±4岁）接受了为期2天的静息-负荷（11名男孩）或为期1天的静息（6名女孩）门控SPECT（99m）Tc-MIBI检查。根据4D-MSPECT软件结果，采用17节段模型，以5分制评估心肌灌注，得出负荷总分、静息总分（SRS）和总分差。心肌灌注异常的范围也以左心室大小的百分比表示。使用4D-MSPECT软件计算左心室舒张末期容积、收缩末期容积（ESV）和射血分数（EF）。

结果

在11例接受静息-负荷门控SPECT（99m）Tc-MIBI检查的儿童中，有7例（64%）发现可逆性心肌灌注缺损。受累的左心室节段为前壁、前间隔、前侧壁、心尖和下壁。与静息研究相比，这7例儿童在负荷时显示出明显更大的灌注异常（18±5%对7±4%，P<0.01），与SRS相比，负荷总分更高（11±4对4±2，P<0.01）。患有心肌缺血的心童和青少年负荷后EF显著低于静息EF（53±12%对59±11%，P<0.05），负荷后ESV显著高于静息ESV（81±24对61±25ml，P<0.05）。在仅进行静息评估的6例儿童中，灌注缺损累及前壁、前间隔和心尖或下外侧节段，占左心室的31±12%，SRS为12±5。他们的左心室整体参数为：舒张末期容积为118±23ml，ESV为56±16ml，EF为51±10%。