Shelton M E, Senneff M J, Ludbrook P A, Sobel B E, Bergmann S R
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110.
J Nucl Med. 1993 May;34(5):717-22.
We have previously shown that myocardial perfusion can be quantified by positron emission tomography (PET) with 15O-labeled water (H2(15)O), as experimentally validated with radiolabeled microspheres in animal hearts. The purpose of our study was to determine whether myocardial nutritive perfusion reserve assessed with PET in human subjects was parallel to flow velocity reserve assessed in conductance vessels measured with intracoronary Doppler probes. We studied nine patients with chest pain and angiographically normal coronary arteries with intracoronary Doppler flow velocity assessments before and after administration of 16 micrograms of intracoronary adenosine. We also assessed myocardial nutritive perfusion with PET and H2(15)O before and after intravenous administration of dipyridamole (0.56 mg/kg). Perfusion reserve (the ratio of absolute values of myocardial perfusion after dipyridamole administration to perfusion at rest) estimated with PET (3.5 +/- 0.9 s.d.) correlated closely with flow velocity reserve (the ratio of hyperemic intracoronary flow velocity to flow velocity at rest) (3.5 +/- 1.2, r = 0.80, p < 0.01). Absolute values of perfusion assessed tomographically averaged 1.22 +/- 0.19 ml/g/min in patients at rest and 4.16 +/- 0.93 after dipyridamole administration. Our data indicate that noninvasive assessment of myocardial perfusion with PET provides results that parallel intracoronary Doppler flow velocity measurements. Because PET delineates nutritive perfusion throughout the heart in absolute terms, its use may facilitate detection of impaired coronary arterial function and enhance delineation of the efficacy of potentially therapeutic interventions in patients with chest pain and angiographically normal coronary arteries.
我们之前已经表明，心肌灌注可以通过正电子发射断层扫描（PET）结合15O标记水（H2(15)O）进行定量，这在动物心脏中已通过放射性标记微球进行了实验验证。我们研究的目的是确定在人类受试者中用PET评估的心肌营养灌注储备是否与用冠状动脉内多普勒探头测量的传导血管中的血流速度储备平行。我们研究了9例胸痛且冠状动脉造影正常的患者，在冠状动脉内给予16微克腺苷前后进行冠状动脉内多普勒血流速度评估。我们还在静脉注射双嘧达莫（0.56 mg/kg）前后用PET和H2(15)O评估心肌营养灌注。用PET估计的灌注储备（双嘧达莫给药后心肌灌注绝对值与静息时灌注的比值）（3.5±0.9标准差）与血流速度储备（充血时冠状动脉血流速度与静息时血流速度的比值）（3.5±1.2，r = 0.80，p < 0.01）密切相关。断层扫描评估的灌注绝对值在静息患者中平均为1.22±0.19 ml/g/min，双嘧达莫给药后为4.16±0.93。我们的数据表明，用PET对心肌灌注进行无创评估所提供的结果与冠状动脉内多普勒血流速度测量结果平行。由于PET能绝对地描绘整个心脏的营养灌注，其应用可能有助于检测冠状动脉功能受损，并增强对胸痛且冠状动脉造影正常的患者潜在治疗干预效果的描绘。
