Wadhwa S S, Mansberg R, Fernandes V B
Department of Nuclear Medicine, Wollongong Hospital, NSW, Australia.
Clin Nucl Med. 1999 Jan;24(1):1-5. doi: 10.1097/00003072-199901000-00001.
TI-201 myocardial perfusion SPECT is commonly used to assess myocardial perfusion and viability. Nitrate-augmented redistribution with repeated injection facilitates the detection of reversible segments compared with standard redistribution. In this study, we investigated the potential of nitrate augmentation to improve myocardial perfusion and viability assessment without repeated injection and we also compared nitrate-augmented redistribution with delayed redistribution.
Eighteen patients underwent a stress-redistribution TI-201 SPECT study. Immediately after redistribution SPECT, each patient was administered 0.6 mg glyceryl trinitrate and nitrate-augmented redistribution SPECT acquired 30 minutes later. Each patient then returned the next day and was injected with a booster dose of TI-201 30 minutes before the delayed redistribution SPECT acquisition. For each SPECT study, the myocardium was divided into 11 segments, and perfusion to each segment was scored on a four-point scale by consensus. An overall cardiac perfusion score was derived by summing the perfusion score for each segment.
Reduced stress perfusion was identified in 150 segments: 23 (15.3%) had improved perfusion after redistribution; 60 (40%) segments had improved perfusion after nitrate-augmented redistribution; 52 (34.7%) segments with reduced stress perfusion had improved perfusion after delayed redistribution. The cardiac perfusion score after stress was 15.9+/-5.5 (means+/-SD). The score increased to 17.4+/-5.4 after redistribution. The perfusion score improved to 19.7+/-5.8 (P < 0.05 versus redistribution) after nitrate augmentation. The cardiac perfusion score, 19.2+/-6.4, did not improve further after delayed redistribution.
TI-201 SPECT with nitrate-augmented redistribution is as good or better than delayed redistribution with repeated injection for myocardial perfusion and viability assessment. TI-201 SPECT with nitrate-augmented redistribution has significant logistical and economic advantages over traditional delayed redistribution with TI-201 repeated injection.
TI-201心肌灌注单光子发射计算机断层扫描（SPECT）常用于评估心肌灌注和存活情况。与标准再分布相比，重复注射硝酸酯增强的再分布有助于检测可逆节段。在本研究中，我们探讨了硝酸酯增强在不重复注射情况下改善心肌灌注和存活评估的潜力，并且我们还比较了硝酸酯增强的再分布与延迟再分布。
18例患者接受了负荷-再分布TI-201 SPECT检查。再分布SPECT检查后立即给每位患者静脉注射0.6mg硝酸甘油，并于30分钟后进行硝酸酯增强的再分布SPECT检查。然后每位患者于次日返回，在延迟再分布SPECT检查前30分钟注射一剂增强剂量的TI-201。对于每次SPECT检查，将心肌分为11个节段，通过共识以四点量表对每个节段的灌注情况进行评分。通过对每个节段的灌注评分求和得出总体心脏灌注评分。
在150个节段中发现负荷灌注降低：23个节段（15.3%）在再分布后灌注改善；60个节段（40%）在硝酸酯增强的再分布后灌注改善；52个负荷灌注降低的节段（34.7%）在延迟再分布后灌注改善。负荷后心脏灌注评分为15.9±5.5（均值±标准差）。再分布后评分增至17.4±5.4。硝酸酯增强后灌注评分改善至19.7±5.8（与再分布相比，P<0.05）。延迟再分布后心脏灌注评分19.2±6.4未进一步改善。
对于心肌灌注和存活评估，硝酸酯增强的再分布TI-201 SPECT与重复注射的延迟再分布效果相当或更好。与传统的TI-201重复注射延迟再分布相比，硝酸酯增强的再分布TI-201 SPECT具有显著的后勤和经济优势。
