Yamada T, Nohara R, Ono S, Kambara H, Kawai C, Tamaki N, Ohtani H, Yamashita K, Yonekura Y, Konishi J
Department of Internal Medicine, Kyoto University.
Kokyu To Junkan. 1990 Jun;38(6):585-8.
False-positive Tl-201 scintigraphy in patients with complete left bundle-branch block (CLBBB) and normal coronary artery had been reported by several authors. However the reason for this phenomenon remained to be clarified. We investigated 2 patients (case 1; a 65-year-old male, case 2; a 58-year-old male) with CLBBB using positron emission computed tomography (PET). Coronary angiography revealed normal coronary artery in both cases. In both cases, Tl-201 stress scintigraphy demonstrated definite perfusion defect at the anteroseptal region without redistribution, although PET study using F-18 fluorodeoxyglucose (18F-FDG) revealed defect at the septal wall. This indicates that perfusion defect detected by Tl-201 scintigraphy relates rather not to ischemic myocardium with a viable region, but to necrotic or fibrous tissue. Thus, PET is a useful tool in investigating viability of abnormal myocardium when other study has failed to do so. Our cases with CLBBB suggested that there was abnormal flow and metabolism at the anteroseptal region, possibly relating to the pathogenesis of CLBBB.
已有多位作者报道，完全性左束支传导阻滞（CLBBB）且冠状动脉正常的患者存在铊-201闪烁扫描假阳性。然而，这一现象的原因仍有待阐明。我们使用正电子发射计算机断层扫描（PET）对2例CLBBB患者（病例1：一名65岁男性，病例2：一名58岁男性）进行了研究。冠状动脉造影显示两例患者冠状动脉均正常。在这两例患者中，铊-201负荷闪烁扫描显示前间隔区域有明确的灌注缺损且无再分布，尽管使用氟-18氟脱氧葡萄糖（18F-FDG）的PET研究显示室间隔壁有缺损。这表明铊-201闪烁扫描检测到的灌注缺损并非与具有存活区域的缺血心肌相关，而是与坏死或纤维组织相关。因此，当其他检查无法做到时，PET是研究异常心肌存活能力的有用工具。我们的CLBBB病例表明，前间隔区域存在异常血流和代谢，这可能与CLBBB的发病机制有关。
