Sobic-Saranovic Dragana P, Pavlovic Smiljana V, Jovanovic Ida V, Stefanovic Igor D, Artiko Vera M, Djukic Milan M, Obradovic Vladimir B
Institute for Nuclear Medicine, Clinical Center of Serbia, Belgrade, Serbia.
Nucl Med Commun. 2010 Jan;31(1):12-21. doi: 10.1097/MNM.0b013e3283295622.
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).
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).
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%.
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.
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。
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）。
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%。
负荷和静息门控SPECT（99m）Tc-MIBI结果表明，患有严重CHD的儿童和青少年在心肌灌注和左心室功能方面存在一系列异常，这有助于确定形态学畸形的功能重要性。因此，门控SPECT（99m）Tc-MIBI提供了补充信息，可指导患有严重CHD的儿童和青少年的临床决策。
