Matzer L, Kiat H, Wang F P, Van Train K, Germano G, Friedman J, Berman D S
Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Am Heart J. 1994 Dec;128(6 Pt 1):1067-76. doi: 10.1016/0002-8703(94)90735-8.
Separate-acquisition rest thallium-201/exercise technetium-99m sestamibi (sestamibi) dual-isotope single-photon emission computed tomography (SPECT) has been shown to be effective for assessment of myocardial perfusion and viability. The present study was designed to validate the dual-isotope approach when used in conjunction with pharmacologic stress. All patients had rest 201TI SPECT followed immediately by adenosine (n = 82) or dipyridamole (n = 50) infusion and sestamibi injection. Sestamibi SPECT was performed 1 hour later. The entire study lasted < 2.5 hours. The patient population was categorized into three groups: 51 consecutive patients with coronary angiography and no previous myocardial infarction (group I), 58 consecutive patients with a low prescintigraphic test likelihood of coronary artery disease (group II), and 23 consecutive catheterized patients with remote Q-wave myocardial infarction (group III). For group I patients, the sensitivity and specificity for dual-isotope SPECT were 92% (35 of 38) and 85% (11 of 13), respectively, when > or = 50% coronary artery narrowing was considered significant and were 97% (34 of 35) and 81% (13 of 16) respectively, when > or = 70% narrowing was considered significant. The normalcy rate among the 58 patients of group II was 96%. Comparisons for pattern of stress-defect reversibility demonstrated that of the 97 stress defects within the infarct zones (group III), 15% were reversible and 85% were nonreversible. In contrast, of the 227 stress defects within the diseased (> or = 50% stenosis) vessel zones of the group I patients, 93% were reversible and 7% were noreversible (p < 0.001 vs group III). In conclusion, separate acquisition rest 201-TI/pharmacologic stress sestamibi dual-isotope SPECT is an efficient myocardial perfusion imaging protocol with high accuracy for detection and assessment of angiographically significant coronary artery disease.
单独采集静息态铊 - 201/运动态锝 - 99m 甲氧基异丁基异腈（sestamibi）双同位素单光子发射计算机断层扫描（SPECT）已被证明对评估心肌灌注和存活能力有效。本研究旨在验证双同位素方法与药物负荷试验联合使用时的效果。所有患者均先进行静息态铊 - 201 SPECT，随后立即静脉输注腺苷（n = 82）或双嘧达莫（n = 50）并注射 sestamibi。1 小时后进行 sestamibi SPECT。整个研究持续时间<2.5 小时。患者群体分为三组：51 例连续的冠状动脉造影且无既往心肌梗死病史的患者（I 组），58 例连续的冠状动脉疾病预闪烁扫描试验可能性较低的患者（II 组），以及 23 例连续的有陈旧性 Q 波心肌梗死的导管检查患者（III 组）。对于 I 组患者，当冠状动脉狭窄≥50%被视为有意义时，双同位素 SPECT 的敏感性和特异性分别为 92%（38 例中的 35 例）和 85%（13 例中的 11 例）；当冠状动脉狭窄≥70%被视为有意义时，敏感性和特异性分别为 97%（35 例中的 34 例）和 81%（16 例中的 13 例）。II 组的 58 例患者中正常率为 96%。应激缺陷可逆性模式的比较表明，在梗死区域（III 组）的 97 个应激缺陷中，15%是可逆的，85%是不可逆的。相比之下，I 组患者病变血管区域（狭窄≥50%）内的 227 个应激缺陷中，93%是可逆的，7%是不可逆的（与 III 组相比，p < 0.001）。总之，单独采集静息态铊 - 201/药物负荷试验 sestamibi 双同位素 SPECT 是一种高效的心肌灌注成像方案，对检测和评估血管造影显示有意义的冠状动脉疾病具有较高的准确性。
