在药物性冠状动脉扩张期间通过心肌灌注成像对冠状动脉狭窄进行无创评估。VIII. 使用发生器产生的铷-82 进行无需回旋加速器的正电子心脏成像的临床可行性。

Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. VIII. Clinical feasibility of positron cardiac imaging without a cyclotron using generator-produced rubidium-82.

作者信息

Gould K L, Goldstein R A, Mullani N A, Kirkeeide R L, Wong W H, Tewson T J, Berridge M S, Bolomey L A, Hartz R K, Smalling R W

出版信息

J Am Coll Cardiol. 1986 Apr;7(4):775-89. doi: 10.1016/s0735-1097(86)80336-9.

DOI:10.1016/s0735-1097(86)80336-9

PMID:3485669

Abstract

The purpose of this study was to determine the clinical feasibility of diagnosing significant coronary artery disease by positron imaging of myocardial perfusion without a cyclotron, using generator-produced rubidium-82 (82Rb). Fifty patients underwent positron emission tomography of the entire heart using a multislice positron camera and intravenous 82Rb or nitrogen-13 ammonia (13NH3) before and after intravenous dipyridamole combined with handgrip stress. Images were read by two observers blinded as to clinical or arteriographic data. Automated quantitative coronary arteriography was obtained for the arteriographic determination of coronary flow reserve, previously demonstrated to be a single integrated measure of stenosis severity accounting for all its geometric dimensions of length, absolute diameter, percent narrowing and asymmetry by quantitative analysis of cine films. Significant coronary artery disease was defined as an arteriographically determined coronary flow reserve of less than 3.0 based on all stenosis dimensions. Any single geometric measure of stenosis severity alone was an inadequate reference standard for comparison with perfusion images. Sensitivity of identifying patients with coronary artery disease having an arteriographically determined coronary flow reserve of less than 3.0 was 95% by positron imaging with a specificity of 100%. The single case that was missed, studied with 13NH3, had a 43% diameter narrowing of a small ramus intermedius off the left coronary artery with no significant narrowing of the major coronary arteries. Positron emission tomography of myocardial perfusion before and after intravenous dipyridamole combined with handgrip stress utilizing generator-produced 82Rb provides sensitive and specific diagnosis of reduced coronary flow reserve due to coronary artery disease in humans.

摘要

本研究的目的是确定使用发生器产生的铷 - 82（82Rb）在无需回旋加速器的情况下通过心肌灌注正电子成像诊断严重冠状动脉疾病的临床可行性。50例患者在静脉注射双嘧达莫联合握力应激前后，使用多层正电子相机及静脉注射82Rb或氮 - 13氨（13NH3）对整个心脏进行正电子发射断层扫描。由两名对临床或血管造影数据不知情的观察者解读图像。通过自动定量冠状动脉造影术来测定冠状动脉血流储备，此前已证明通过对电影胶片进行定量分析，冠状动脉血流储备是狭窄严重程度的单一综合指标，可考虑其长度、绝对直径、狭窄百分比和不对称性等所有几何维度。严重冠状动脉疾病定义为基于所有狭窄维度血管造影确定的冠状动脉血流储备小于3.0。单独的任何一项狭窄严重程度的几何测量指标都不足以作为与灌注图像比较的参考标准。通过正电子成像识别冠状动脉血流储备血管造影确定小于3.0的冠状动脉疾病患者的敏感性为95%，特异性为100%。漏诊的唯一一例患者，使用13NH3进行研究，其左冠状动脉的一小分支中间支直径狭窄43%，主要冠状动脉无明显狭窄。静脉注射双嘧达莫联合握力应激前后利用发生器产生的82Rb进行心肌灌注正电子发射断层扫描可对人类因冠状动脉疾病导致的冠状动脉血流储备降低提供敏感且特异的诊断。