使用碘-123-BMIPP进行脂肪酸代谢成像诊断冠状动脉疾病

Fatty acid metabolic imaging with iodine-123-BMIPP for the diagnosis of coronary artery disease.

作者信息

Fujiwara S, Takeishi Y, Atsumi H, Takahashi K, Tomoike H

机构信息

First Department of Internal Medicine, Yamagata University School of Medicine, Japan.

出版信息

J Nucl Med. 1997 Feb;38(2):175-80.

PMID:9025730

Abstract

UNLABELLED

Iodine-123-BMIPP kinetics under high glucose levels were examined. The feasibility of 123I-BMIPP imaging after oral glucose loading for the detection of impaired fatty acid metabolism was tested in patients with coronary artery disease.

METHODS

Fatty acid metabolic imaging with 123I-BMIPP was performed on 29 patients in the fasting state and repeated after oral glucose loading. Myocardial SPECT images were obtained 20 min and 4 hr after the injection of 123I-BMIPP. Myocardial uptake of 123I-BMIPP was calculated by a Ishii-Macintyre method and the clearance of 123I-BMIPP from the myocardium was determined as (early counts-delayed counts) x 100/early counts. Regional accumulation of 123I-BMIPP was scored semiquantitatively from 0 (normal) to 4 (no activity), and the sum of regional scores in each patient was defined as a total defect score (TDS).

RESULTS

Total myocardial uptake of 123I-BMIPP was 1.7% +/- 0.4% in the fasting state and 1.6% +/- 0.3% after oral glucose loading (p < 0.05). Iodine-123-BMIPP clearance from the myocardium was faster after glucose loading than in the fasting state (27% +/- 8% versus 11% +/- 6%, p < 0.01). After glucose loading, 123I-BMIPP clearance was faster in the ischemic myocardium (defined as areas perfused by stenosed coronary artery exceeding 90%) than in the nonischemic myocardium (33% +/- 8% versus 25% +/- 9%, p < 0.05). TDS in the ischemic myocardium increased from 1.8 +/- 0.4 in the fasting state to 2.1 +/- 0.4 after glucose loading (p < 0.01). The sensitivity for detecting coronary stenosis exceeding 90% increased from 55% (11/20) in the fasting state to 75% (15/20) after glucose loading without a loss of specificity (78%, 7/9).

CONCLUSION

Oral glucose loading enhanced the detection of areas with impaired fatty acid metabolism due to coronary artery narrowing. Iodine-123-BMIPP imaging with oral glucose loading may be a new approach for the noninvasive diagnosis of coronary artery disease.

摘要

未标记

研究了高血糖水平下碘-123-BMIPP的动力学。在冠状动脉疾病患者中测试了口服葡萄糖负荷后进行123I-BMIPP成像检测脂肪酸代谢受损的可行性。

方法

对29例患者在空腹状态下进行123I-BMIPP脂肪酸代谢成像，并在口服葡萄糖负荷后重复进行。在注射123I-BMIPP后20分钟和4小时获取心肌SPECT图像。采用石井-麦金太尔法计算心肌对123I-BMIPP的摄取，并将123I-BMIPP从心肌中的清除率确定为（早期计数-延迟计数）×100/早期计数。123I-BMIPP的区域积聚从0（正常）到4（无活性）进行半定量评分，每位患者的区域评分总和定义为总缺损评分（TDS）。

结果

空腹状态下心肌对123I-BMIPP的总摄取为1.7%±0.4%，口服葡萄糖负荷后为1.6%±0.3%（p<0.05）。葡萄糖负荷后123I-BMIPP从心肌中的清除比空腹状态更快（27%±8%对11%±6%，p<0.01）。葡萄糖负荷后，缺血心肌（定义为狭窄冠状动脉供血面积超过90%的区域）中123I-BMIPP的清除比非缺血心肌更快（33%±8%对25%±9%，p<0.05）。缺血心肌的TDS从空腹状态下的1.8±0.4增加到葡萄糖负荷后的2.1±0.4（p<0.01）。检测冠状动脉狭窄超过90%的敏感性从空腹状态下的55%（11/20）增加到葡萄糖负荷后的75%（15/20），而特异性未降低（78%，7/9）。