González P, Massardo T, Muñoz A, Jofré J, Rivera A, Yovanovich J, Maiers E, Ayala F, Humeres P, Ramírez A, Arriagada M, Zavala A
Nuclear Medicine Section and Cardiovascular Center, University of Chile, Santiago.
Eur J Nucl Med. 1996 Oct;23(10):1315-22. doi: 10.1007/BF01367586.
The main goal of this study was to evaluate whether the addition of ECG gating to technetium-99m sestamibi single-photon emission tomographic (SPET) perfusion imaging assists the prediction of recovery of regional wall motion abnormalities after revascularization. Thirty-six patients with coronary artery disease were included in the study. All had wall motion abnormalities, and 31 (86%) had a clinical history of myocardial infarction. Coronary artery bypass surgery was performed in 18 patients and angioplasty in the remainder. All underwent ECG-gated and non-gated SPET at rest and after intravenous dipyridamole. Two-dimensional echocardiography was performed at a mean of 27 days before revascularization and at a mean of 69 days following revascularization to assess segmental wall motion changes. Perfusion prior to revascularization was analysed qualitatively and quantitatively on gated and non-gated SPET, and the results compared with those of echocardiography. Bullseye parameters were obtained from a normal database, generated from data in 40 normal volunteers, using dipyridamole ECG-gated and non-gated sestamibi SPET. There was good concordance between gated and non-gated qualitative analysis (79% with kappa=0.65) for normal, viable or necrotic segments. Gated SPET predicted functional recovery in 27 of 35 (77%) segments showing echocardiographic improvement while non-gated SPET did so in 30 of 39 (77%) such segments. Gated SPET predicted no functional recovery in 20 of 45 (44%) segments that did not show improved wall motion after revascularization, while with non-gated SPET the figure was 18 of 51 (35%). The positive predictive values of gated and non-gated SPET with regard to the recovery of wall motion following revascularization were 52% and 48%, while the negative predictive values were 71% and 67%, respectively. 99mTc-sestamibi had a low predictive value for recovery of function if visual assessment was used in the analysis of SPET data. Quantitative bullseye sestamibi parameters (defect extension and severity, reversibility and percentage change in extension), from gated or non-gated studies, appear best to distinguish which segments will display improved motility on the echocardiogram after revascularization. The addition of ECG gating does not significantly increase the predictive value of SPET imaging with regard to recovery of function.
本研究的主要目的是评估在锝-99m 甲氧基异丁基异腈单光子发射断层扫描（SPET）灌注成像中添加心电图门控是否有助于预测血运重建后局部室壁运动异常的恢复情况。36 例冠心病患者纳入本研究。所有患者均有室壁运动异常，31 例（86%）有心肌梗死病史。18 例患者接受冠状动脉搭桥手术，其余患者接受血管成形术。所有患者在静息状态下及静脉注射双嘧达莫后均接受了心电图门控和非门控的 SPET 检查。在血运重建前平均 27 天和血运重建后平均 69 天进行二维超声心动图检查，以评估节段性室壁运动变化。对门控和非门控 SPET 上血运重建前的灌注进行定性和定量分析，并将结果与超声心动图结果进行比较。通过 40 名正常志愿者在使用双嘧达莫心电图门控和非门控甲氧基异丁基异腈 SPET 检查时的数据建立正常数据库，从中获取靶心参数。对于正常、存活或坏死节段，门控和非门控定性分析之间有良好的一致性（79%，kappa = 0.65）。门控 SPET 在 35 个显示超声心动图改善的节段中的 27 个（77%）预测了功能恢复，而非门控 SPET 在 39 个此类节段中的 30 个（77%）预测了功能恢复。门控 SPET 在血运重建后室壁运动未改善的 45 个节段中的 20 个（44%）预测无功能恢复，而非门控 SPET 在 51 个节段中的 18 个（35%）预测无功能恢复。门控和非门控 SPET 对血运重建后室壁运动恢复的阳性预测值分别为 52%和 48%，阴性预测值分别为 71%和 67%。如果在 SPET 数据分析中使用视觉评估，99mTc-甲氧基异丁基异腈对功能恢复的预测价值较低。来自门控或非门控研究的定量靶心甲氧基异丁基异腈参数（缺损范围和严重程度、可逆性以及范围变化百分比）似乎最能区分哪些节段在血运重建后超声心动图上会显示运动改善。添加心电图门控并未显著增加 SPET 成像对功能恢复的预测价值。
