Department of Nuclear Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Clin Nucl Med. 2011 Mar;36(3):199-205. doi: 10.1097/RLU.0b013e318208f117.
Muscle weakness has been repeatedly reported in patients with carbon monoxide (CO) intoxication. In animal models, CO intoxication has been linked with mitochondrial electron transport dysfunction. The objectives of the present study were to use Tc-99m sestamibi thigh single-photon emission computed tomography/computed tomography (SPECT/CT) to evaluate the mitochondrial status in patients with CO intoxication, correlate this with clinical parameters, and compare with age-matched controls.
A total of 25 patients with delayed sequelae after CO intoxication (range: 1-60 months) and 17 sex- and age-matched healthy volunteers underwent Tc-99m sestamibi thigh SPECT/CT. Cognitive evaluation and muscle power according to medical research council (MRC) grading were collected. Both visual scoring from planar images and automatic volumetric analysis were used to rate the Tc-99m sestamibi uptake level.
The visual scores showed that 14 patients (56.0%) were scored as moderate-to-severe decrement. Volumetric analysis showed that a significant Tc99m-sestamibi uptake decrement was found in the CO intoxication group as compared with the controls, and 16 patients (64.0%) had uptakes below 1 standard deviation of the control group. In the CO group, the muscle power but not the cognitive evaluation correlated with Tc-99m sestamibi uptake in muscles. The decrement of muscle Tc99m-sestamibi uptake was related to mitochondria swelling, increased mitochondrial numbers, and type II muscle atrophy in 1 patient.
In this study, we demonstrated that patients with CO intoxication sustained defective mitochondrial metabolism in skeletal muscles as revealed by a decrement in Tc-99m sestamibi uptake either by visual or semiquantification of thigh SPECT/CT. Tc-99m sestamibi scanning provided noninvasive measurement of mitochondrial injury in muscles after CO intoxication and the correlation with clinical parameters was good.
肌肉无力已在一氧化碳（CO）中毒患者中反复报道。在动物模型中，CO 中毒与线粒体电子传递功能障碍有关。本研究的目的是使用 Tc-99m 甲氧基异丁基异腈大腿单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）来评估 CO 中毒患者的线粒体状态，将其与临床参数相关联，并与年龄匹配的对照组进行比较。
共有 25 名 CO 中毒后出现迟发性后遗症的患者（范围：1-60 个月）和 17 名性别和年龄匹配的健康志愿者接受了 Tc-99m 甲氧基异丁基异腈大腿 SPECT/CT。收集认知评估和根据医学研究委员会（MRC）分级的肌肉力量。使用平面图像的视觉评分和自动容积分析来评估 Tc-99m 甲氧基异丁基异腈摄取水平。
视觉评分显示，14 名患者（56.0%）被评为中度至重度下降。体积分析显示，与对照组相比，CO 中毒组 Tc99m-甲氧基异丁基异腈摄取明显减少，16 名患者（64.0%）摄取量低于对照组的 1 个标准差。在 CO 组中，肌肉力量而不是认知评估与肌肉 Tc-99m 甲氧基异丁基异腈摄取相关。1 名患者的肌肉 Tc-99m 甲氧基异丁基异腈摄取减少与线粒体肿胀、线粒体数量增加和 II 型肌肉萎缩有关。
在这项研究中，我们证明了 CO 中毒患者的骨骼肌存在缺陷的线粒体代谢，这表现为 Tc-99m 甲氧基异丁基异腈摄取减少，无论是通过大腿 SPECT/CT 的视觉评分还是半定量评分。Tc-99m 甲氧基异丁基异腈扫描提供了 CO 中毒后肌肉线粒体损伤的非侵入性测量，与临床参数的相关性良好。
