[123I-间碘苄胍心肌显像的定量分析：评估其在充血性心力衰竭患者中的应用价值]

[Quantitative analysis of 123I-metaiodobenzylguanidine myocardial imaging: assessment of its usefulness in patients with congestive heart failure].

作者信息

Narita M, Kurihara T, Murano K, Usami M, Honda M

机构信息

Department of Internal Medicine, Sumitomo Hospital.

出版信息

Kaku Igaku. 1994 Apr;31(4):347-58.

PMID:8196231

Abstract

To investigate the usefulness of the quantitative analysis of 123I-metaiodobenzylguanidine (123I-MIBG) myocardial uptake, we studied 9 normal subjects and 18 patients with congestive heart failure (CHF). Rest myocardial imaging with 123I-MIBG was performed at 20 minutes and 3 hours (delayed image) after 123I-MIBG injection. Rest 201Tl imaging was obtained at 20 minutes after 201Tl injection. In addition to ordinary tomograms, a planar anterior image and a whole body image were supplemented in each imaging. In patients with CHF fractional shortening (%FS) was calculated from echocardiography and left ventricular ejection fraction was obtained from cardiac blood pool imaging with 99mTc at rest. We calculated H/M (heart to mediastinum count ratio) from the anterior planar image and %Uptake (percentage of cardiac uptake of the isotope to total injected dose) from the whole body image. H/M of 123I-MIBG in delayed images separated patients with CHF from normal subjects (2.00 +/- 0.19 vs. 2.56 +/- 0.13, p < 0.01). H/M Ratio (H/M of 123I-MIBG divided by H/M of 201Tl) in delayed image could distinguish these two groups poorly (0.72 +/- 0.12 vs. 0.88 +/- 0.14, p < 0.05). On the other hand, %Uptake of 123I-MIBG was not different between two groups (3.49 +/- 0.60% in CHF, 3.54 +/- 0.34% in normal). But %Uptake of 201Tl was greater in CHF than in normal (5.96 +/- 1.09% vs. 4.70 +/- 0.30%, p < 0.05). When myocardial 123I-MIBG uptake was normalized by myocardial perfusion (%Uptake of 123I-MIBG divided by %Uptake of 201Tl, Uptake Ratio), Uptake Ratio in delayed image could distinguish theses two groups as same as H/M (0.60 +/- 0.05 in CHF, 0.75 +/- 0.05 in normal, p < 0.01). In patients with CHF, H/M of 123I-MIBG did not reflect LV function and serum norepinephrine (NE) level. But Uptake Ratio and H/M Ratio in delayed image correlated well with %FS (r = 0.88, r = 0.65), EF (r = 0.80, r = 0.68) and NE level (r = -0.77, r = -0.75). Although the calculation of Uptake Ratio is time consuming and expensive, it was assumed that Uptake Ratio is an useful index to quantitate myocardial 123I-MIBG uptake.

摘要

为研究123I-间碘苄胍（123I-MIBG）心肌摄取定量分析的实用性，我们对9名正常受试者和18名充血性心力衰竭（CHF）患者进行了研究。在注射123I-MIBG后20分钟和3小时（延迟影像）进行123I-MIBG静息心肌显像。在注射201Tl后20分钟进行201Tl静息显像。除了常规断层显像外，每次显像还补充了前位平面影像和全身影像。对于CHF患者，通过超声心动图计算缩短分数（%FS），并通过静息状态下99mTc心血池显像获得左心室射血分数。我们从前位平面影像计算H/M（心脏与纵隔计数比），并从全身影像计算%摄取率（同位素心脏摄取量占总注射剂量的百分比）。延迟影像中123I-MIBG的H/M可将CHF患者与正常受试者区分开来（2.00±0.19对2.56±0.13，p<0.01）。延迟影像中的H/M比值（123I-MIBG的H/M除以201Tl的H/M）对这两组的区分能力较差（0.72±0.12对0.88±0.14，p<0.05）。另一方面，两组间123I-MIBG的%摄取率无差异（CHF组为3.49±0.60%，正常组为3.54±0.34%）。但CHF患者201Tl的%摄取率高于正常组（5.96±1.09%对4.70±0.30%，p<0.05）。当心肌123I-MIBG摄取量通过心肌灌注进行标准化时（123I-MIBG的%摄取率除以201Tl的%摄取率，摄取率比值），延迟影像中的摄取率比值与H/M一样能够区分这两组（CHF组为0.60±0.05，正常组为0.75±0.05，p<0.01）。在CHF患者中，123I-MIBG的H/M不能反映左心室功能和血清去甲肾上腺素（NE）水平。但延迟影像中的摄取率比值和H/M比值与%FS（r=0.88，r=0.65）、EF（r=0.80，r=0.68）和NE水平（r=-0.77，r=-0.75）相关性良好。尽管摄取率比值的计算耗时且昂贵，但据推测摄取率比值是定量心肌123I-MIBG摄取的有用指标。