Kodama K, Igase M, Kazatani Y, Matsuzaki K, Murakami E, Kokubu T
Department of Internal Medicine, Kinki Central Hospital, Itami, Japan.
J Nucl Med. 1995 Nov;36(11):2050-2.
A 64-yr-old woman, who had no history of anginal attack, underwent cholecystectomy under general anesthesia. A few hours after successful surgery, the EKG showed T-wave inversions with QT-interval prolongations and torsades de pointes. The [123I]MIBG scintigraphic findings revealed marked denervation in the anteroseptal and inferoposterior myocardium, whereas 201TI myocardial SPECT showed only slightly reduced tracer uptake in those areas. The [123I]BMIPP scans showed abnormal fatty acid metabolism in the anteroseptal myocardium. Coronary angiogram detected no fixed stenosis, but coronary vasoconstriction in the left anterior descending artery was induced by intracoronary injection of acetylcholine. In our patient, the findings of cardiac imaging with [123I]MIBG, 201TI and [123I]BMIPP led to coronary angiography and the final diagnosis of probable perioperative coronary vasospasm.
一位64岁无心绞痛发作史的女性在全身麻醉下接受了胆囊切除术。手术成功数小时后，心电图显示T波倒置，QT间期延长，并出现尖端扭转型室速。[123I]间碘苄胍闪烁显像结果显示前间隔和下后壁心肌有明显的去神经支配，而201铊心肌单光子发射计算机断层扫描显示这些区域仅示踪剂摄取略有减少。[123I]β-甲基-对碘苯十五酸扫描显示前间隔心肌脂肪酸代谢异常。冠状动脉造影未发现固定性狭窄，但冠状动脉内注射乙酰胆碱可诱发左前降支冠状动脉血管收缩。在我们的患者中，[123I]间碘苄胍、201铊和[123I]β-甲基-对碘苯十五酸心脏成像结果促使进行冠状动脉造影，并最终诊断为可能的围手术期冠状动脉痉挛。
