Howarth D M, Forstrom L A, Samudrala V, Sinak L J, McGregor C G, Rodeheffer R J
Department of Nuclear Medicine, Mayo Clinic, Rochester MN 55905, USA.
Nucl Med Commun. 1996 Feb;17(2):105-13. doi: 10.1097/00006231-199602000-00003.
Accelerated coronary artery disease is a common complication following orthotopic cardiac transplantation. The relationship between acute rejection and accelerated coronary artery disease remains unclear. While thallium-201 (201Tl) imaging has been advocated in the diagnosis of post-transplant coronary arteriopathy, other investigators have found little role for this technique in the evaluation of such patients. We undertook a retrospective review of 13 stress/rest (10 exercise, 2 dobutamine, 1 dipyridamole) and 2 rest/rest 201Tl single photon emission tomographic (SPET) imaging studies performed in seven patients post-cardiac transplantation (mean duration post transplantation = 2.5 years). Four of these patients had serial studies with an average interval between studies of 8.3 months (range 3-14 months). Coronary angiography was performed within 12 months of each 201Tl study (mean = 4.2 months). Using the coronary angiographic diagnostic criterion of > or = 50% stenosis in one or more vessels, one or more fixed or reversible segmental defects were found on 201Tl imaging with a sensitivity of 78% and specificity of 33%. When the angiographic criterion of > 70% stenosis in one or more vessels was used the sensitivity increased to 100%, and where reversible segments were diagnostic the sensitivity was 67% and the specificity range from 42 to 58%. Although based on a small sample of patients, these results suggest that use of appropriate test methods and interpretive criteria may improve the utility of 201Tl SPET myocardial imaging in the diagnosis of coronary artery disease in cardiac transplant patients. Limited specificity may reflect associated pathological processes in these patients, including rejection, oedema and focal inflammation.
加速性冠状动脉疾病是原位心脏移植术后常见的并发症。急性排斥反应与加速性冠状动脉疾病之间的关系仍不明确。虽然有人主张用铊-201（²⁰¹Tl）显像来诊断移植后冠状动脉病变，但其他研究者发现该技术在评估这类患者时作用不大。我们对7例心脏移植患者（移植后平均病程 = 2.5年）进行的13次负荷/静息（10次运动、2次多巴酚丁胺、1次双嘧达莫）及2次静息/静息²⁰¹Tl单光子发射断层扫描（SPET）显像研究进行了回顾性分析。其中4例患者进行了系列研究，研究之间的平均间隔为8.3个月（范围3 - 14个月）。在每次²⁰¹Tl研究后的12个月内进行了冠状动脉造影（平均 = 4.2个月）。采用冠状动脉造影诊断标准，即一支或多支血管狭窄≥50%，在²⁰¹Tl显像上发现一处或多处固定或可逆性节段性缺损，其敏感性为78%，特异性为33%。当采用一支或多支血管狭窄＞70%的造影标准时，敏感性增至100%，若以可逆性节段为诊断标准，则敏感性为67%，特异性范围为42%至58%。尽管基于少量患者样本，但这些结果表明，使用适当的检测方法和解释标准可能会提高²⁰¹Tl SPET心肌显像在诊断心脏移植患者冠状动脉疾病中的效用。特异性有限可能反映了这些患者存在的相关病理过程，包括排斥反应、水肿和局灶性炎症。
