Cowley M J, Mantle J A, Rogers W J, Russel R O, Rackley C E, Logic J R
Circulation. 1977 Aug;56(2):192-8. doi: 10.1161/01.cir.56.2.192.
Two hundred-three patients had -echnetium 99m (stannous) pyrophosphate myocardial scintigrams for the evaluation of chest pain and suspected acute myocardial infarction. In addition to routine imaging at 60--90 minutes after injection of the radio-pharmaceutical, the blood pool was imaged immediately in each patient for comparison with routine anterior, left anterior oblique, and left lateral views. Further delayed studies were obtained when residual blood pool activity was identified. Seventy patients had acute myocardial infarction by clinical, electrocardiographic, and enzymatic (CK-MB) criteria. Sixty-five of these 70 patients with acute infarction had positive myocardial scintigrams, with one technically unsatisfactory study. Only four of the 70 patients had negative scintigrams when imaged 18--72 hours after infarction in this study. Technically satisfactory scintigrams were recorded in 125 patients without evidence of infarction. Ninety-six had negative scintigrams at 60--90 minutes, while 19 patients (15%) had precordial activity at 60--90 minutes which was identical in distribution to early blood pool images and cleared with further delay. With these included, the true negative incidence was 92%. Ten of 125 patients had false positive scintigrams; two had recent cardioversion with resultant chest wall damage. The other eight patients had previous infarction 1 1/2 to 72 months earlier and had akinetic segments shown angiographically in the areas of the persistently positive scintigrams. Myocardial scintigraphy correlates well with the presence of other evidence of acute infarction, as well as with the absence of acute infarction when residual blood pool activity is identified. False positive scintigrams can occur following cardioversion and in patients with previous myocardial infarction and resultant ventricular wall motion abnormalities.
203例患者接受了锝99m（亚锡）焦磷酸盐心肌闪烁扫描，以评估胸痛及疑似急性心肌梗死。除了在注射放射性药物后60至90分钟进行常规成像外，还对每位患者立即进行血池成像，以便与常规前位、左前斜位和左侧位图像进行比较。当发现有残留血池活性时，进行进一步延迟检查。根据临床、心电图和酶学（肌酸激酶同工酶）标准，70例患者患有急性心肌梗死。这70例急性梗死患者中有65例心肌闪烁扫描呈阳性，其中1例检查结果技术上不满意。在本研究中，这70例患者中只有4例在梗死后18至72小时成像时闪烁扫描呈阴性。125例无梗死证据的患者获得了技术上满意的闪烁扫描结果。96例在60至90分钟时闪烁扫描呈阴性，而19例患者（15%）在60至90分钟时心前区有活性，其分布与早期血池图像相同，并随进一步延迟而消退。将这些情况包括在内，真阴性发生率为92%。125例患者中有10例闪烁扫描呈假阳性；2例近期进行了心脏复律，导致胸壁损伤。另外8例患者在1个半月至72个月前有过心肌梗死，在持续阳性闪烁扫描区域的血管造影显示有运动减弱节段。心肌闪烁扫描与急性梗死的其他证据的存在以及在发现残留血池活性时无急性梗死的情况相关性良好。心脏复律后以及有既往心肌梗死及由此导致的心室壁运动异常的患者可能出现假阳性闪烁扫描结果。
