van Eck-Smit B L, van der Wall E E, Zwinderman A H, Pauwels E K
Department of Diagnostic Radiology and Nuclear Medicine, University of Leiden, The Netherlands.
Nucl Med Commun. 1995 Oct;16(10):811-20.
Thallium-201 (201Tl) stress-redistribution/reinjection imaging provides a reliable diagnostic approach in patients evaluated for myocardial ischaemia. Immediate reinjection of 201Tl after completing the stress images followed by imaging 1 h later shortens the investigation time to 2.5 h and may provide a novel approach. In this study, we validated the immediate reinjection approach in the assessment of myocardial perfusion and viability using contrast angiographic findings as the reference standard. We studied 114 patients with documented cardiac catheterization data using quantitative planar 201Tl stress/immediate reinjection imaging. The 201Tl findings were compared with contrast angiographic data, coronary arteriographic findings and electrocardiographic data. Myocardial regions were considered to be viable if they (1) showed normal or hypokinetic wall motion, (2) were supplied by patent coronary arteries or by occluded arteries with adequate collateral circulation, or (3) were not related to electrocardiographic infarct site. Myocardial regions were considered to be non-viable if they (1) showed akinetic or dyskinetic wall motion, (2) were supplied by occluded vessels with inadequate collateral circulation, or (3) were related to electrocardiographic infarct site. Of 280 regions with normal or hypokinetic wall motion, 47 (17%) regions showed persistent 201Tl defects compared with 21 of 26 (81%) regions with akinetic/dyskinetic wall motion (P < 0.0001). Of 318 regions supplied by patent vessels, 65 (20%) regions showed persistent 201Tl defects compared with 14 of 22 (64%) regions subtended by occluded vessels (P < 0.0001). When the 201Tl findings were compared with electrocardiographic infarct site, 37 of 259 (14%) remote regions showed persistent defects compared with 42 of 83 (51%) infarct-related regions (P < 0.0001). We conclude that persistent defects on 201Tl immediate reinjection images are significantly more often associated with severe left ventricular wall motion abnormalities, coronary artery occlusion and infarct-related regions. In particular, agreement between the wall motion approach and scintigraphic findings was excellent, with 21 of 26 akinetic or dyskinetic segments showing persistent defects and 233 of 280 normal or hypokinetic segments measured as viable by the reinjection technique, resulting in a sensitivity of 81%, a specificity of 83% and an overall accuracy of 83%. These findings show the potential of immediate 201Tl reinjection imaging for assessing myocardial perfusion and viability.
铊 - 201（²⁰¹Tl）负荷 - 再分布/再注射成像为评估心肌缺血的患者提供了一种可靠的诊断方法。在完成负荷图像后立即注射²⁰¹Tl，随后1小时后成像，可将检查时间缩短至2.5小时，并可能提供一种新方法。在本研究中，我们以对比血管造影结果作为参考标准，验证了立即再注射方法在评估心肌灌注和存活能力方面的有效性。我们使用定量平面²⁰¹Tl负荷/立即再注射成像研究了114例有心脏导管插入术数据记录的患者。将²⁰¹Tl检查结果与对比血管造影数据、冠状动脉造影结果和心电图数据进行比较。如果心肌区域（1）显示正常或运动减弱的室壁运动，（2）由通畅的冠状动脉或有足够侧支循环的闭塞动脉供血，或（3）与心电图梗死部位无关，则认为该心肌区域有存活能力。如果心肌区域（1）显示无运动或运动障碍的室壁运动，（2）由侧支循环不足的闭塞血管供血，或（3）与心电图梗死部位有关，则认为该心肌区域无存活能力。在280个室壁运动正常或减弱的区域中，47个（17%）区域显示²⁰¹Tl持续缺损，相比之下，26个（81%）室壁运动无运动/运动障碍的区域中有21个出现²⁰¹Tl持续缺损（P < 0.0001）。在由通畅血管供血的318个区域中，65个（20%）区域显示²⁰¹Tl持续缺损，相比之下，由闭塞血管供血的22个区域中有14个（64%）出现²⁰¹Tl持续缺损（P < 0.0001）。当将²⁰¹Tl检查结果与心电图梗死部位进行比较时，259个（14%）远离梗死部位的区域中有37个显示持续缺损，相比之下，83个梗死相关区域中有42个（51%）出现持续缺损（P < 0.0001）。我们得出结论，²⁰¹Tl立即再注射图像上的持续缺损更常与严重的左心室壁运动异常、冠状动脉闭塞和梗死相关区域相关。特别是，室壁运动方法与闪烁显像结果之间的一致性非常好，26个无运动或运动障碍节段中有21个显示持续缺损，再注射技术测量的280个正常或运动减弱节段中有233个被判定为有存活能力，敏感性为81%，特异性为83%，总体准确性为83%。这些结果表明²⁰¹Tl立即再注射成像在评估心肌灌注和存活能力方面具有潜力。
