van Eck-Smit B L, van der Wall E E, Zwinderman A H, Pauwels E K
Department of Diagnostic Radiology and Nuclear Medicine, University Hospital Leiden, The Netherlands.
Eur Heart J. 1995 Mar;16(3):410-20. doi: 10.1093/oxfordjournals.eurheartj.a060926.
Immediate reinjection of thallium-201 after acquisition of the stress images followed by imaging 60 min later has been proposed as a novel time-saving and patient-convenient approach for the evaluation of myocardial ischaemia and viability. The objective of this study was to establish the clinical value of thallium-201 stress immediate reinjection imaging in the evaluation of patients with suspected and known coronary artery disease. Quantitative planar thallium-201 stress immediate reinjection imaging was performed in 138 patients with undiagnosed chest pain, of whom 114 underwent cardiac catheterization and 24 had a < 5% likelihood for coronary artery disease; 56 patients had previously suffered a myocardial infarction. Sensitivities and accuracies were determined for coronary artery disease, reversible myocardial ischaemia, and myocardial viability. Of the 138 patients studied for coronary artery disease, thallium stress scintigraphy identified 85 of 93 patients with angiographically proven coronary artery lesions (overall sensitivity 91%). The normalcy rate in the low-likelihood patients was 88% (21 of 24 patients) and the overall diagnostic accuracy was 83%. In the 56 patients who had suffered a previous myocardial infarction, and in whom the suitability for reversible ischaemia was sought, the overall patient-related sensitivity and accuracy were 93% and 92% respectively. In the 56 patients with a previous myocardial infarction a total of 168 vessel regions were studied to detect viability. Of the 142 normal or hypokinetic regions, 127 regions were scintigraphically identified as viable (sensitivity 89%). The thallium stress immediate reinjection imaging protocol is an appropriate clinical approach in patients with undiagnosed chest pain. The combined identification of stress-induced ischaemia and viability by thallium stress immediate reinjection imaging provides adequate algorithms allowing optimal management and risk assessment in the individual cardiac patient.
在采集负荷图像后立即再次注射铊 - 201，随后在60分钟后进行成像，已被提议作为一种评估心肌缺血和存活能力的新颖省时且方便患者的方法。本研究的目的是确定铊 - 201负荷即刻再注射成像在评估疑似和已知冠状动脉疾病患者中的临床价值。对138例未确诊胸痛的患者进行了定量平面铊 - 201负荷即刻再注射成像，其中114例接受了心导管检查，24例冠状动脉疾病可能性小于5%；56例患者曾发生过心肌梗死。确定了冠状动脉疾病、可逆性心肌缺血和心肌存活能力的敏感性和准确性。在研究冠状动脉疾病的138例患者中，铊负荷闪烁显像在93例经血管造影证实有冠状动脉病变的患者中识别出85例（总体敏感性91%）。低可能性患者的正常率为88%（24例患者中的21例），总体诊断准确性为83%。在56例曾发生过心肌梗死且寻求可逆性缺血适用性的患者中，总体与患者相关的敏感性和准确性分别为93%和92%。在56例曾发生过心肌梗死的患者中，共研究了168个血管区域以检测存活能力。在142个正常或运动减弱区域中，127个区域经闪烁显像被识别为存活（敏感性89%）。铊负荷即刻再注射成像方案是未确诊胸痛患者的一种合适临床方法。通过铊负荷即刻再注射成像联合识别负荷诱导的缺血和存活能力，提供了足够的算法，允许对个体心脏病患者进行最佳管理和风险评估。
