Li L X, Nohara R, Okuda K, Hosokawa R, Hata T, Tanaka M, Matsumori A, Fujita M, Tamaki N, Konishi J, Sasayama S
Department of Internal Medicine, Kyoto University, Japan.
Ann Nucl Med. 1996 Aug;10(3):307-14. doi: 10.1007/BF03164737.
The objective of the present study was to characterize the production of 201Tl myocardial perfusion defects, the relation between the 201Tl multiple small defects and the myocardial damage indicated by myocardial fibrosis shown histopathologically in patients with dilated cardiomyopathy (DCM). Rest 201Tl scintigraphy was performed in thirty-seven patients with myocardial tissue fibrosis by endomyocardial biopsy, and without stenosis of the coronary artery. 201Tl myocardial SPECT images were visually classified into 4 grades according to the severity of inhomogeneous perfusion defects (IPD), 0: none, 1: slight, 2: moderate, 3: severe. 201Tl uptake, defect regions (DR), and coefficient of variation % (CV%) were also quantified by Bull's eye quantification in nineteen patients. During cardiac catheterization, three biopsy specimens were obtained from the lateral wall to the apical region of the left ventricle and the amount of fibrosis was assessed by means of light microscopic morphometry. The myocardial fibrosis was also classified into 4 grades by a point-counting method. Autopsy study was also assessed in six patients. 201Tl perfusion defects were observed in 35 (94.6%) patients, of whom 29 (78.4%) showed inhomogeneous perfusion defects. Twenty-four (64.9%) showed Stage 0 and 201Tl findings, and 21 (62.2%) had myocardial fibrosis in stage 1. Clinically, the correlation between the grades of the IPD, % 201Tl uptake, DR and CV% of myocardial uptake, which were calculated semiquantitatively by Bull's eye image, and the histological grades of fibrosis were also good (IPD vs. fibrosis: r = 0.7014; % 201Tl uptake vs. fibrosis: r = -0.6542; DR vs. fibrosis: r = 0.7027; CV% vs. fibrosis: r = 0.6985). The 201Tl SPECT findings were in close agreement with the severity of myocardial fibrosis confirmed by autopsy, but the grading of the IPD was not related to the ejection fraction or left ventricular diameter. It showed a higher rate of inhomogeneous 201Tl myocardial perfusion defects (78.4%) in patients with DCM. This result may contribute to the clinical evaluation of DCM or differentiation from other diseases. Furthermore, the grading of 201Tl inhomogeneous perfusion defects related to the myocardial fibrosis of left ventricular myocardium may contribute to speculation of the myocardial degenerative stage in clinical settings.
本研究的目的是描述201铊心肌灌注缺损的产生情况，以及扩张型心肌病（DCM）患者中201铊多个小缺损与组织病理学显示的心肌纤维化所指示的心肌损伤之间的关系。对37例经心内膜心肌活检证实有心肌组织纤维化且无冠状动脉狭窄的患者进行静息201铊闪烁扫描。根据不均匀灌注缺损（IPD）的严重程度，将201铊心肌单光子发射计算机断层扫描（SPECT）图像视觉上分为4级，0级：无，1级：轻度，2级：中度，3级：重度。还对19例患者通过靶心定量法对201铊摄取、缺损区域（DR）和变异系数百分比（CV%）进行了量化。在心脏导管插入术期间，从左心室侧壁至心尖区域获取三个活检标本，并通过光学显微镜形态计量学评估纤维化程度。心肌纤维化也通过点计数法分为4级。还对6例患者进行了尸检研究。35例（94.6%）患者观察到201铊灌注缺损，其中29例（78.4%）显示不均匀灌注缺损。24例（64.9%）显示0期及201铊检查结果，21例（62.2%）心肌纤维化处于1期。临床上，通过靶心图像半定量计算的IPD分级、201铊摄取百分比、DR和心肌摄取的CV%与纤维化的组织学分级之间也具有良好的相关性（IPD与纤维化：r = 0.7014；201铊摄取百分比与纤维化：r = -0.6542；DR与纤维化：r = 0.7027；CV%与纤维化：r = 0.6985）。201铊SPECT检查结果与尸检证实的心肌纤维化严重程度密切一致，但IPD分级与射血分数或左心室直径无关。DCM患者中显示出较高比例的不均匀201铊心肌灌注缺损（78.4%）。这一结果可能有助于DCM的临床评估或与其他疾病的鉴别。此外，与左心室心肌纤维化相关的201铊不均匀灌注缺损分级可能有助于临床推测心肌退变阶段。
