Sakata K, Yoshida H, Ono N, Ohtani S, Mori N, Yokoyama S, Hoshino T, Kaburagi T, Kurata C
Department of Cardiology, Shizuoka General Hospital, Japan.
Jpn Circ J. 1993 Jan;57(1):27-36. doi: 10.1253/jcj.57.27.
This study aimed investigate whether thallium-201 and technetium-99m pyrophosphate dual rest-redistribution emission computed tomography early after intracoronary thrombolysis may provide supplementary information for the management of patients with acute myocardial infarction. Fifty patients who received intracoronary thrombolysis underwent simultaneous dual emission computed tomography 3 days after first acute myocardial infarction. All patients who had a technetium-99m pyrophosphate accumulation were selected. Thallium-201/technetium-99m pyrophosphate overlap in the initial and delayed images early after intracoronary thrombolysis identified successful recanalization with sensitivities of 68% and 90% (p < 0.05), specificities of 47% 79% (p < 0.05), positive predictive accuracies of 68% and 88%, negative predictive accuracies of 47% and 80% (p < 0.05), and overall accuracy of 60% and 86% (p < 0.01), respectively. The patients were divided into 3 groups according to the change in thallium-201 uptake from the initial image to the delayed image on dual emission computed tomography: 20 patients had no change in thallium-201 uptake (fixed type), 16 had increases in thallium-201 uptake (redistribution type), and 14 had decreases in thallium-201 uptake (reverse redistribution type). The number of patients with successful recanalization was significantly higher in the redistribution type than in the other types (redistribution type vs reverse redistribution type or fixed type; p < 0.01, respectively). In the redistribution type a frequency of reinfarction in the same infarcted area during the hospital course was significantly higher than in the other types (redistribution type vs reverse redistribution type or fixed type; p < 0.05, respectively), which was mainly due to the patients having high grade residual stenosis. Thus, a thallium-201/technetium-99m pyrophosphate overlap in the delayed image early after acute myocardial infarction can be used as an index for predicting successful early recanalization and probably viable myocardium. In addition, the redistribution patterns on thallium-201 emission computed tomography early after intracoronary thrombolysis can be helpful in identifying patients with successful early recanalization and a high risk subset.
本研究旨在探讨冠状动脉内溶栓术后早期行铊 - 201和焦磷酸锝 - 99m双时相心肌灌注断层显像能否为急性心肌梗死患者的治疗提供补充信息。50例接受冠状动脉内溶栓的患者在首次急性心肌梗死后3天行同步双时相心肌灌注断层显像。选取所有焦磷酸锝 - 99m有蓄积的患者。冠状动脉内溶栓术后早期，初始图像与延迟图像上铊 - 201/焦磷酸锝 - 99m的重叠情况可识别成功再灌注，其敏感性分别为68%和90%（p < 0.05），特异性分别为47%和79%（p < 0.05），阳性预测准确率分别为68%和88%，阴性预测准确率分别为47%和80%（p < 0.05），总体准确率分别为60%和86%（p < 0.01）。根据双时相心肌灌注断层显像上铊 - 201摄取从初始图像到延迟图像的变化，将患者分为3组：20例患者铊 - 201摄取无变化（固定型），16例铊 - 201摄取增加（再分布型），14例铊 - 201摄取减少（反向再分布型）。再分布型患者成功再灌注的例数显著高于其他类型（再分布型与反向再分布型或固定型相比；p均 < 0.01）。再分布型患者在住院期间同一梗死区域再次梗死的发生率显著高于其他类型（再分布型与反向再分布型或固定型相比；p均 < 0.05），这主要是由于患者存在高度残余狭窄。因此，急性心肌梗死后早期延迟图像上铊 - 201/焦磷酸锝 - 99m的重叠可作为预测早期成功再灌注及可能存活心肌的指标。此外，冠状动脉内溶栓术后早期铊 - 201心肌灌注断层显像的再分布模式有助于识别早期成功再灌注患者及高危亚组。
