Kanna M, Mitani I, Nakamaru M, Shibuya K, Takeda K, Asahina S, Kitamura Y, Higuma K, Ishii M
Division of Cardiology, Yokosuka City Hospital, Kanagawa.
J Cardiol. 1998 Oct;32(4):253-61.
Simultaneous assessment of stress perfusion and rest function is possible with gated single photon emission computed tomography (SPECT) using stress injected technetium-99m (99mTc) tetrofosmin (TF). The feasibility of dipyridamole stress electrocardiographic gated myocardial SPECT (GSPECT) with TF was examined as an alternative to conventional stress/rest imaging. Fifty-one patients underwent stress GSPECT. 740 MBq of TF was administered 3 min after dipyridamole infusion. GSPECT acquisition was performed one hour after the injection. Additional rest SPECT was performed on another day only in patients with abnormal perfusion on stress images. Perfusion and thickening were analyzed visually on 17 segments of the left ventricle. Percentage of wall thickening (%WT) was also calculated in 17 segments of the polar map. Thirty-two of 51 patients (63%) had normal stress perfusion and normal rest thickening. Nineteen of 51 patients (37%) had abnormal perfusion on stress images. Among 157 abnormal perfusion segments of the 19 patients, 139 segments (89%) had thickening and the rest (11%) had no thickening. %WT was higher in the reversible segments with or without thickening. There was better agreement for the identification of normal segments and the presence of reversibility between stress GSPECT and the conventional stress/rest study in patients without previous myocardial infarction than in those with previous myocardial infarction (89% vs 79%). These results suggest that stress GSPECT may substitute for conventional stress/rest perfusion study in patients without previous myocardial infarction, allowing shorter examination time and lower cost. However, stress GSPECT does not replace the need for rest perfusion study in patients with previous myocardial infarction, because of underestimation of viability, but %WT may eliminate this underestimation.
使用静脉注射的锝-99m（99mTc）替曲膦（TF）进行门控单光子发射计算机断层扫描（SPECT），可以同时评估应激灌注和静息功能。本研究探讨了双嘧达莫负荷心电图门控心肌SPECT（GSPECT）联合TF作为传统负荷/静息成像替代方法的可行性。51例患者接受了负荷GSPECT检查。在输注双嘧达莫3分钟后给予740MBq的TF。注射后1小时进行GSPECT采集。仅对负荷图像灌注异常的患者在另一天进行额外的静息SPECT检查。对左心室的17个节段进行视觉分析灌注和增厚情况。还在极坐标图的17个节段中计算壁增厚百分比（%WT）。51例患者中有32例（63%）负荷灌注正常且静息增厚正常。51例患者中有19例（37%）负荷图像灌注异常。在这19例患者的157个灌注异常节段中，139个节段（89%）有增厚，其余节段（11%）无增厚。有或无增厚的可逆节段中%WT较高。与有既往心肌梗死的患者相比，无既往心肌梗死的患者在负荷GSPECT与传统负荷/静息研究之间对正常节段的识别和可逆性的存在有更好的一致性（89%对79%）。这些结果表明，对于无既往心肌梗死的患者，负荷GSPECT可能替代传统的负荷/静息灌注研究，从而缩短检查时间并降低成本。然而，由于对存活心肌的低估，负荷GSPECT不能替代有既往心肌梗死患者的静息灌注研究，但%WT可能消除这种低估。
