Meneguetti J C, Camargo E E, Soares J, Bellotti G, Bocchi E, Higuchi M L, Stolff N, Hironaka F H, Buchpiguel C A, Pileggi F
Instituto do Coração, Universidade de São Paulo, Brazil.
J Heart Transplant. 1987 May-Jun;6(3):171-6.
Endomyocardial biopsy seems to be the most accurate method to use for diagnosis and follow-up of acute rejection of the transplanted heart. This investigation compared a noninvasive procedure, gallium-67 imaging, with endomyocardial biopsy in the detection of acute rejection in heart transplantation. Seven male patients (aged 41 to 54 years) sequentially had 46 gallium-67 scintigrams and 46 endomyocardial biopsies between 1 week and 8 months after transplantation. Both studies were obtained in the same day, 48 hours after the administration of an intravenous injection of gallium-67 citrate. Cardiac uptake was graded as negative, mild, moderate, and marked according to an increasing count ratio with rib and sternal uptakes. Histologic findings were graded as negative, mild acute rejection, moderate acute rejection, severe acute rejection, resolving rejection, and nonspecific reaction. Negative biopsies were not found with moderate uptake, and neither moderate nor severe acute rejection were found with negative scintigrams. Imaging sensitivity was 83% with 17% false negatives and 9% false positives. Of seven studies with moderate uptake, five showed moderate acute rejection, and the patients had specific therapy with a decline in uptake, which correlated with resolving rejection. It is conceivable that in the future this technique may be used as a screening procedure for sequential endomyocardial biopsies in the follow-up of heart transplant patients.
心内膜心肌活检似乎是用于诊断和随访移植心脏急性排斥反应的最准确方法。本研究比较了一种非侵入性检查方法——镓-67显像，与心内膜心肌活检在心脏移植急性排斥反应检测中的效果。7名男性患者（年龄41至54岁）在移植后1周和8个月期间依次进行了46次镓-67闪烁扫描和46次心内膜心肌活检。两项检查均在静脉注射枸橼酸镓-67后48小时的同一天进行。根据心脏与肋骨及胸骨摄取的计数比值增加，将心脏摄取分为阴性、轻度、中度和明显四级。组织学检查结果分为阴性、轻度急性排斥反应、中度急性排斥反应、重度急性排斥反应、正在消退的排斥反应和非特异性反应。中度摄取时未发现活检结果为阴性的情况，闪烁扫描结果为阴性时也未发现中度或重度急性排斥反应。显像的敏感性为83%，假阴性率为17%，假阳性率为9%。在7次中度摄取的检查中，5次显示为中度急性排斥反应，患者接受了特异性治疗，摄取量下降，这与排斥反应的消退相关。可以想象，在未来，这项技术可能会被用作心脏移植患者随访中连续心内膜心肌活检的筛查程序。
