Ikeda H, Shibao K, Yoh M, Tanabe A, Shimamatsu M, Hiyamuta K, Ohkita Y, Sugi K, Koga Y, Utsu F
J Cardiogr. 1985 Sep;15(3):603-12.
Regional myocardial perfusion was evaluated by computerized washout analysis of digital subtraction angiography (DSA) images. Diatrizoate meglumine (76% Urografin), 2 to 3 ml, was manually injected into the left main coronary artery. For 26 patients with ischemic heart disease (IHD), 14 patients with cardiomyopathy, and eight patients with normal coronary angiograms, DSA images of myocardial perfusions were obtained in the right anterior oblique projection. These were digitized into an image-processing computer. Time-density curves were constructed in four segments of the left ventricle perfused by the left anterior descending coronary artery (LAD) and the contrast decay half-lives (T1/2) were calculated from the decay phases of the curves, using mono-exponential least square fits. The mean T1/2 was significantly longer in patients with 75% or more LAD narrowing than in those with normal coronary arteries. By contrast, patients with 50% or less LAD narrowing had T1/2 comparable to those with normal coronary arteries. In patients with IHD, there was a significant curvilinear relationship of T1/2 with percent stenosis of the LAD. This indicates that a decrease in regional myocardial flow develops rapidly in coronary stenosis of 70-80% or more. In patients with comparable coronary stenosis, T1/2 was significantly longer in the asynergic regions than in those with normal wall motion, but T1/2 was shorter in regions perfused by collateral vessels. These findings indicate that left ventricular contraction and collateral flow could contribute to regional myocardial perfusion. In addition, patients with hypertrophic and dilated cardiomyopathy had prolonged T1/2 despite normal coronary angiograms, suggesting abnormalities in intramural coronary arteries. Thus, T1/2 derived by computerized washout analysis of DSA myocardial image proved to be a useful index for quantitative evaluation of regional myocardial perfusion.
通过数字减影血管造影（DSA）图像的计算机洗脱分析来评估局部心肌灌注。将2至3毫升的泛影葡胺（76%优维显）手动注入左冠状动脉主干。对26例缺血性心脏病（IHD）患者、14例心肌病患者和8例冠状动脉造影正常的患者，在右前斜位获得心肌灌注的DSA图像。这些图像被数字化输入图像处理计算机。在由左前降支冠状动脉（LAD）灌注的左心室四个节段构建时间-密度曲线，并使用单指数最小二乘法拟合从曲线的衰减阶段计算对比剂衰减半衰期（T1/2）。LAD狭窄75%或以上的患者的平均T1/2显著长于冠状动脉正常的患者。相比之下，LAD狭窄50%或以下的患者的T1/2与冠状动脉正常的患者相当。在IHD患者中，T1/2与LAD狭窄百分比之间存在显著的曲线关系。这表明在70 - 80%或更高的冠状动脉狭窄中，局部心肌血流迅速减少。在冠状动脉狭窄程度相当的患者中，无运动区域的T1/2显著长于室壁运动正常的区域，但侧支血管灌注区域的T1/2较短。这些发现表明左心室收缩和侧支血流可能有助于局部心肌灌注。此外，肥厚型和扩张型心肌病患者尽管冠状动脉造影正常，但T1/2延长，提示壁内冠状动脉存在异常。因此，通过DSA心肌图像的计算机洗脱分析得出的T1/2被证明是定量评估局部心肌灌注的有用指标。
