Schoeder H, Friedrich M, Topp H
Department of Radiology and Nuclear Medicine, Urban Hospital Berlin, Germany.
Eur J Nucl Med. 1993 Sep;20(9):792-803. doi: 10.1007/BF00180911.
Coronary revascularization in patients with chronic coronary heart disease (CHD) or acute myocardial infarction (AMI) is mainly based on factors such as coronary anatomy, ventricular function, accompanying diseases and the patient's biological age. Rest- or exercise-induced ischaemia should be proven before a bypass operation or percutaneous transluminal coronary angioplasty. Although a significant amount of ischaemic but still viable myocardium is a necessary condition for successful revascularization, the detection of viable myocardium is of major importance in a rather small subset of patients. These are patients with hibernating (or a combination of hibernating and stunned) myocardium in whom the aforementioned parameters do not yield an unequivocal result. Thallium-201 myocardial scintigraphy with re-injection or rest-redistribution is an established, proven and cost-effective way of detecting viable myocardium. Other methods such as positron emission tomography with different tracers or technetium-99m sestamibi SPET are discussed and compared to thallium-201 SPET. In conclusion, the detection of ischaemic but still viable myocardium is of importance in only a rather small subset of patients with CHD. In this context thallium-201 myocardial SPET is and still remains the method of choice.
慢性冠心病（CHD）或急性心肌梗死（AMI）患者的冠状动脉血运重建主要基于冠状动脉解剖结构、心室功能、伴随疾病以及患者的生物学年龄等因素。在进行搭桥手术或经皮冠状动脉腔内血管成形术之前，应证实存在静息或运动诱发的缺血。尽管大量缺血但仍存活的心肌是成功进行血运重建的必要条件，但在相当一部分患者中，检测存活心肌至关重要。这些患者存在冬眠（或冬眠与顿抑并存）心肌，上述参数无法得出明确结果。采用再注射或静息-再分布的铊-201心肌闪烁扫描是检测存活心肌的一种成熟、可靠且经济有效的方法。还讨论了其他方法，如使用不同示踪剂的正电子发射断层扫描或锝-99m 甲氧基异丁基异腈单光子发射计算机断层扫描，并与铊-201单光子发射计算机断层扫描进行了比较。总之，检测缺血但仍存活的心肌仅在一小部分冠心病患者中具有重要意义。在此背景下，铊-201心肌单光子发射计算机断层扫描过去是、现在仍然是首选方法。
