Kauffman G J, Boyne T S, Watson D D, Smith W H, Beller G A
Cardiovascular Division, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
J Am Coll Cardiol. 1996 Jun;27(7):1592-7. doi: 10.1016/0735-1097(96)00090-3.
We prospectively compared myocardial uptake of thallium-201 (201Tl) at rest with rest technetium-99m (99mTc) sestamibi uptake in the same patients, using quantitative singlephoton emission computed tomography (SPECT).
Because of only slightly delayed redistribution, 99mTc-sestamibi uptake at rest may be less than 201Tl uptake, thereby underestimating the extent of viability.
Twenty patients (2.25 stenoses per patient) with a mean left ventricular ejection fraction of 33 +/- 2% underwent early and 3-h delayed rest 201Tl SPECT, rest 99mTc-sestamibi SPECT and two-dimensional echocardiography.
The 280 scan segments were classified as either a normal, mild reduction in viability, defined as delayed 201Tl uptake < or = 75% and > or = 5%, or a severe reduction in viability, defined as delayed 201Tl uptake < 50%. Mild and severe defects were further classified as fixed or having rest 201Tl redistribution. Comparisons by patients were made using repeated measures analysis of variance and Dunnett's multiple comparisons test to compare 99mTc-sestamibi with initial rest 201Tl and delayed 201Tl uptake. Twenty patients had at least one mild fixed defect (95 total segments). The average percent uptake in these defects for initial 201Tl, delayed 201Tl and 99mTc-sestamibi was 62.5 +/- 2.7%, 63.1 +/- 7.1% and 67.3 +/- 9.7%, respectively (p = NS). Twelve patients (27 segments) had mild redistribution defects on serial rest 201Tl imaging. The average percent uptake was 61.6 +/- 5.2% for initial 201Tl, 67.0 +/- 9.1% for delayed 201Tl and 67.7 +/- 12.4% for 99mTc-sestamibi defects. Technetium-99m sestamibi uptake was not significantly different than that for delayed 201Tl but was significantly greater than initial 201Tl uptake. Seventeen patients (52 segments) had severe fixed 201Tl defects. The average percent uptake was 38.9 +/- 7.3% for initial 201Tl, 38.3 +/- 12.2% for delayed 201Tl and 42.7 +/- 14.2% for 99mTc-sestamibi defects in these patients (p = NS). Ten patients (19 segments) had severe redistribution defects on rest 201Tl imaging. The average percent uptake was 37.0 +/- 8.5% for initial 201Tl, 42.9 +/- 8.6% for delayed 201Tl and 44.5 +/- 11.3% for 99mTc-sestamibi defects. As was seen for mild 201Tl redistribution defects, 99mTc-sestamibi uptake was significantly higher than initial 201Tl uptake, but not significantly different than delayed 201Tl uptake in these severe defects.
Technetium-99m sestamibi uptake after injection at rest is comparable to 201Tl uptake after injection at rest in patients with severe coronary artery disease and left ventricular dysfunction, suggesting comparable worth for viability assessment.
我们采用定量单光子发射计算机断层扫描（SPECT），对同一组患者静息状态下铊 - 201（201Tl）的心肌摄取情况与静息状态下锝 - 99m（99mTc）甲氧基异丁基异腈的摄取情况进行前瞻性比较。
由于仅有轻微延迟再分布，静息状态下99mTc - 甲氧基异丁基异腈的摄取可能低于201Tl摄取，从而低估存活心肌范围。
20例患者（平均每位患者有2.25处狭窄），平均左心室射血分数为33±2%，接受了早期和3小时延迟静息201Tl SPECT、静息99mTc - 甲氧基异丁基异腈SPECT以及二维超声心动图检查。
280个扫描节段被分类为正常、存活心肌轻度减低（定义为延迟201Tl摄取≤75%且≥5%）或存活心肌严重减低（定义为延迟201Tl摄取＜50%）。轻度和重度缺损进一步分为固定性或有静息201Tl再分布。采用重复测量方差分析和Dunnett多重比较检验对患者进行比较，以比较99mTc - 甲氧基异丁基异腈与初始静息201Tl及延迟201Tl摄取情况。20例患者至少有一处轻度固定性缺损（共95个节段）。这些缺损处初始201Tl、延迟201Tl和99mTc - 甲氧基异丁基异腈的平均摄取百分比分别为62.5±2.7%、63.1±7.1%和67.3±9.7%（p =无显著差异）。12例患者（27个节段）在连续静息201Tl显像中有轻度再分布缺损。初始201Tl、延迟201Tl和99mTc - 甲氧基异丁基异腈缺损处的平均摄取百分比分别为61.6±5.2%、67.0±9.1%和67.7±12.4%。99mTc - 甲氧基异丁基异腈摄取与延迟201Tl摄取无显著差异，但显著高于初始201Tl摄取。17例患者（52个节段）有严重固定性201Tl缺损。这些患者初始201Tl、延迟201Tl和99mTc - 甲氧基异丁基异腈缺损处的平均摄取百分比分别为38.9±7.3%、38.3±12.2%和42.7±14.2%（p =无显著差异）。10例患者（19个节段）在静息201Tl显像中有严重再分布缺损。初始201Tl、延迟201Tl和99mTc - 甲氧基异丁基异腈缺损处的平均摄取百分比分别为37.0±8.5%、42.9±8.6%和44.5±11.3%。与轻度201Tl再分布缺损情况一样，在这些严重缺损中，99mTc - 甲氧基异丁基异腈摄取显著高于初始201Tl摄取，但与延迟201Tl摄取无显著差异。
对于严重冠状动脉疾病和左心室功能障碍患者，静息注射后99mTc - 甲氧基异丁基异腈的摄取与静息注射后201Tl的摄取相当，提示在存活心肌评估方面价值相当。
