铊-201再注射显像时的反向再分布与冠状动脉病变、室壁运动异常及组织存活能力相关。

Thallium-201 reverse redistribution at reinjection imaging correlated with coronary lesion, wall motion abnormality and tissue viability.

作者信息

Marzullo P, Gimelli A, Cuocolo A, Pace L, Marcassa C, Sambuceti G, Galli M, Giorgetti A, Stefanini S, Parodi O, L'Abbate A

机构信息

CNR Institute of Clinical Physiology, Pisa, Italy.

出版信息

J Nucl Med. 1996 May;37(5):735-41.

PMID:8965136

Abstract

UNLABELLED

Previous studies based on standard stress-redistribution 201TI scintigraphy provided conflicting results about the clinical significance 201Tl reverse redistribution. Recent observations indicate that the majority of these defects normalize following reinjection reflecting viable myocardium.

METHODS

In this study, the meaning of reverse redistribution occurring at reinjection imaging, its relation to standard 4-hr redistribution, coronary lesion, abnormal wall motion and tissue viability were assessed. A region with normal activity in the stress image was considered as having reverse redistribution if 201Tl activity at reinjection imaging was definitely abnormal with a decrease in relative tracer uptake >15% of the peak. From a series of 270 patients, 29 showed reverse redistribution. Of these 29 patients, 27 had evidence of previous myocardial infarction. Coronary lesions were detected in all but 1 patient. Average ejection fraction was 0.38 +/- 0.11.

RESULTS

On a segmental basis, 50/377 regions showed the pattern of reverse redistribution. A significant coronary lesion (> or = 50%) was found in 78% of these regions; occlusion rate was 50%, and collateral circulation was found in 35% of occluded vessels. Hypokinesis or akinesis was present in 72% of segments. Tissue viability, defined as an uptake >55% of the peak, was found in 44% of these segments. The 50 segments showing reverse redistribution were divided into two groups according to an abnormal uptake also at 4-hr redistribution (group 1, 25 segments) or appearing only following reinjection (group 2,25 segments). Despite segments of group 1 showing a higher degree of coronary stenosis (80 +/- 32 versus 59 +/- 43%, p < 0.01), a similar rate of coronary occlusion, ventricular dysfunction and maintained viability was found in the two groups.

CONCLUSION

Reverse redistribution in chronic coronary artery disease is frequently associated with significant coronary lesion, collateral-dependent dysfunctioning myocardium and preserved tissue viability. The occurrence of reverse redistribution following reinjection expands the indication for viability imaging to all patients with known coronary artery disease and regional wall motion abnormalities who undergo diagnostic and prognostic 201TI scintigraphy.

摘要

未标记

以往基于标准应力再分布201铊闪烁显像的研究，对于201铊反向再分布的临床意义给出了相互矛盾的结果。近期观察表明，这些缺损中的大多数在再次注射后恢复正常，提示心肌存活。

方法

在本研究中，评估了再次注射显像时出现的反向再分布的意义、其与标准4小时再分布、冠状动脉病变、室壁运动异常及组织存活的关系。如果再次注射显像时201铊活性明显异常，且相对示踪剂摄取减少超过峰值的15%，则将负荷显像中活性正常的区域视为出现反向再分布。在270例患者中，29例显示有反向再分布。在这29例患者中，27例有既往心肌梗死的证据。除1例患者外，其余患者均检测到冠状动脉病变。平均射血分数为0.38±0.11。

结果

在节段水平上，377个节段中有50个显示出反向再分布模式。在这些节段中，78%发现有显著的冠状动脉病变（≥50%）；闭塞率为50%，35%的闭塞血管发现有侧支循环。72%的节段存在运动减弱或运动消失。组织存活（定义为摄取超过峰值的55%）在这些节段的44%中被发现。将显示反向再分布的50个节段根据4小时再分布时摄取也异常（第1组，25个节段）或仅在再次注射后出现异常（第2组，25个节段）分为两组。尽管第1组节段显示冠状动脉狭窄程度较高（80±32%对59±43%，p<0.01），但两组冠状动脉闭塞率、心室功能障碍及存活心肌维持率相似。