Niemeyer M G, Kuijper A F, Meeder J G, Cramer M J, Cleophas A J, van der Wall E E
Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Center, The Netherlands.
Angiology. 1997 Oct;48(10):843-53. doi: 10.1177/000331979704801001.
Assessment of tissue viability has become an important issue in recent years. Scintigraphic measurements have provided important diagnostic, therapeutic, and prognostic information in patients with myocardial dysfunction, who may improve in left ventricular function after revascularization. For detection of regional myocardial ischemia and viability, thallium 201 (201Tl) has been the most widely used tracer in single-photon scintigraphy. However, 201Tl scintigraphy may underestimate regional viability, especially after myocardial infarction. Positron emission tomography (PET) provides an advanced imaging technology that permits the accurate definition of regional tracer distribution. In combination with nitrogen (13N) ammonia, PET allows for the sensitive and specific detection of coronary artery disease. Several studies indicate the superiority of this approach in comparison with standard 201Tl tomographic (SPECT) imaging. In addition, regional blood flow can be accurately measured with 13N ammonia PET, and this approach can be employed in conjunction with pharmacologic stress imaging to quantify regional flow reserve. In combination with metabolic markers, such as fluorine 18 (18F) deoxyglucose, an indicator of glucose uptake, PET is capable of assessing myocardial viability. Furthermore, the PET approach may differentiate between various forms of cardiomyopathy. More studies are needed to define the cost-benefit ratio of both the 201Tl reinjection and the PET technique for the management of patients with coronary artery disease or cardiomyopathy.
近年来，组织活力评估已成为一个重要问题。闪烁扫描测量为心肌功能障碍患者提供了重要的诊断、治疗和预后信息，这些患者在血运重建后左心室功能可能会改善。对于检测局部心肌缺血和活力，铊201（201Tl）一直是单光子闪烁扫描中使用最广泛的示踪剂。然而，201Tl闪烁扫描可能会低估局部活力，尤其是在心肌梗死后。正电子发射断层扫描（PET）提供了一种先进的成像技术，能够准确界定局部示踪剂分布。与氮（13N）氨联合使用时，PET可实现对冠状动脉疾病的灵敏且特异的检测。多项研究表明，与标准的201Tl断层扫描（SPECT）成像相比，这种方法具有优越性。此外，使用13N氨PET能够准确测量局部血流，并且这种方法可与药物负荷成像联合使用以量化局部血流储备。与代谢标记物如氟18（18F）脱氧葡萄糖（一种葡萄糖摄取指标）联合使用时，PET能够评估心肌活力。此外，PET方法可区分各种形式的心肌病。需要更多研究来确定201Tl再注射和PET技术在冠状动脉疾病或心肌病患者管理中的成本效益比。
