Uehara T, Nishimura T, Hayashida K, Naito H, Kozuka T, Park Y D, Sakakibara H
J Cardiogr. 1982 Mar;12(1):101-10.
Myocardial perfusion imaging with thallium chloride has been found to be effective in the clinical evaluation of patients with myocardial infarction. However, conventional myocardial perfusion imaging of the myocardium showing the postero-septal and antero-lateral wall cannot be obtained clearly by the conventional collimator due to the inevitable distance between the collimator and the heart. In contrast, 30, 60-degree RAO images were obtained clearly using slant-hole collimator with the collimator closely contact with the heart, which enables us to observe the postero-septal and antero-lateral walls of the myocardium. As a result, we obtained myocardial perfusion images every 30-degrees in a radial direction. By dividing RAO images into 12 segments, we compared perfusion defect in the myocardial scintigram with akinesis detected by echocardiography and contrast left ventriculography segmentally and referred to the character and accuracy of these three examinations. As a result, these three methods well agreed in cases with myocardial infarction of single vessel disease, but did not always agree in cases with triple vessel disease. The character of each method was as follows: 1) Left ventriculography, which gives direct information concerning wall motion of the left ventricle, was most sensitive to detect ischemic lesions, but had a tendency to overestimate hypokinesis of wall motion due to its invasive nature. 2) In myocardial scintigraphy, when hypoperfusion is associated with perfusion defect, we occasionally diagnose mistakenly the hypoperfusion area as normal because the scintigraphic evaluation is based on the relative distribution of perfusion. To avoid such underestimation, exercise myocardial scintigraphy should be performed and myocardial ischemia should be evaluated by comparing exercise images with redistribution images. Moreover, we studied extension of perfusion defect in the anterior and infero-posterior infarction groups. In anterior myocardial infarction, perfusion defect extended beyond the apex and reached the point one-third away from the apex to the base. In infero-posterior myocardial infarction, perfusion defect extended into the apex but did not exceed the apex. It seemed that the most suitable point to make the boundary between apical and infero-posterior areas was the point one-third away from the apex to the base along the inferior half of the RAO image of the myocardium.
已发现用氯化铊进行心肌灌注成像在心肌梗死患者的临床评估中是有效的。然而，由于准直器与心脏之间不可避免的距离，使用传统准直器无法清晰获得显示后间隔和前侧壁心肌的常规心肌灌注图像。相比之下，使用倾斜孔准直器并使其与心脏紧密接触，可以清晰地获得30度、60度右前斜位图像，这使我们能够观察心肌的后间隔和前侧壁。结果，我们在径向方向上每隔30度获得心肌灌注图像。通过将右前斜位图像分为12个节段，我们将心肌闪烁图中的灌注缺损与超声心动图检测到的运动不能以及对比左心室造影进行节段性比较，并参考这三种检查的特点和准确性。结果，在单支血管病变的心肌梗死病例中，这三种方法的结果吻合良好，但在三支血管病变的病例中并不总是一致。每种方法的特点如下：1）左心室造影可提供有关左心室壁运动的直接信息，对检测缺血性病变最敏感，但由于其有创性，有高估壁运动减弱的倾向。2）在心肌闪烁显像中，当灌注不足与灌注缺损相关时，由于闪烁显像评估基于灌注的相对分布，我们偶尔会将灌注不足区域错误地诊断为正常。为避免这种低估，应进行运动心肌闪烁显像，并通过将运动图像与再分布图像进行比较来评估心肌缺血。此外，我们研究了前壁和下后壁梗死组灌注缺损的范围。在前壁心肌梗死中，灌注缺损超出心尖并延伸至距心尖至心底三分之一处。在下后壁心肌梗死中，灌注缺损延伸至心尖但未超过心尖。似乎在心肌右前斜位图像下半部，沿着从心尖至心底三分之一处是划分心尖和下后壁区域边界的最合适点。
