~（99m）Tc－MIBI心肌断层显像对实验性心肌梗塞和再灌注前后的对比研究

采用导管法对１２只犬进行了持续性冠状动脉血流阻断（６只）及阻断１小时后再开放（６只），并于再灌注前及实验后７天进行了９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）心肌显像，发现两组动物首次显像心肌缺损面积相似（Ｐ＞０．０５），而末次显像再灌注组心肌缺损面积显著小于持续阻断组，前者的缺血心肌改善百分比显著高于后者，末次显像心肌缺损面积与病理证实心肌梗塞面积有较好的相关性（ｒ＝０．７２）．表明９９ｍＴｃ－ＭＩＢＩＳＰＥＣＴ显像是了解急性心肌梗塞范围及再灌注效果的较好手段．     

^99mTc—MIBI心肌断层显像对实验性心肌梗塞和再灌注前后的对…

采用导管法对１２只犬进行了持续性冠状动脉血流阻断及阻断１小时后再开放，并于再灌注前及实验后７天进行了＾９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）心肌显像，发现两组动物首次显像心肌缺损面积相似，而末次显像再灌注组心肌缺损面积显著小于持续阻断组，前者的缺血心肌改善百分比显著高于后者，末次显像心肌缺损面积与病理证实心肌梗塞面积有较好的相关性，表明＾９９ｍＴｃ０ＭＩＢＩＳＰＥＣＴ显像是了解急性心肌梗塞范围及     

~（99m）Tc－MIBISPECT检测梗塞区存活心肌（与~（18）F－FDGPET结果比较）

评价９９ｍＴｃ-甲氧基异丁基异腈（ＭＩＢＩ）ＳＰＥＣＴ定量分析在心肌梗塞（ＭＩ）区存活心肌判断中的准确性，及视觉判断９９ｍＴｃ-ＭＩＢＩＳＰＥＣＴ结果在缺血与坏死心肌鉴别中的局限性．方法：３４例ＭＩ患者进行了９９ｍＴｃ-ＭＩＢＩＳＰＥＣＴ心肌灌注显像及１８Ｆ标记的脱氧葡萄糖（ＦＤＧ）ＰＥＴ显像．结果：当局部心肌９９ｍＴｃ-ＭＩＢＩ放射性小于左室心肌峰计数的４０％，存活心肌存在的可能性仅为２４％左右；相反，当局部９９ｍＴｃ-ＭＩＢＩ放射性大于左室心肌峰计数的４０％，则９０％以上的心肌节段均为存活心肌．故视觉判断不可逆性缺损明显低估存活心肌．约５９％的不可逆性缺损节段在ＰＥＴ显像中有明确１８Ｆ-ＦＤＧ摄取，提示为存活心肌．结论：９９ｍＴｃ-ＭＩＢＩＳＰＥＣＴ定量分析能明显提高存活心肌的定位诊断，慎重判断及定义心肌灌注显像中的不可逆性缺损区，重视定量分析的研究及应用对ＭＩ区存活与坏死心肌的鉴别诊断有重要价值．     

^99mTc—MIBI门控平面心肌显像评价心肌梗塞区存活心肌—与^99mTc…

为评价＾９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）平面门控心肌显像（ＥＧＰ）在心肌梗塞患者存活心肌判断中的生，对２１例心肌梗塞患者进行了静息ＥＧＰ、静息帮动物＾９９ｍＴｃ－ＭＩＢＩ心肌单光子发现计算机断层（ＳＰＥＣＴ）显像及饥饿时静息＾１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电子发射计算机断层（ＰＥＴ）正像。在２１例患者共１０５个心肌节段中，有１５个节段运动ＳＰＥＣＴ半定量分析局部＾９９ｍＴｃ－ＭＩＢＩ放射性     

运动静息介入三步^99mTc—MIBI心肌显像预测PTCA疗效

目的：探讨组合方案的ＳＰＥＣＴ ９９ｍＴｃＭＩＢＩ 心肌显像术前预测ＰＴＣＡ 疗效的价值。材料与方法：采用运动、静息、静滴硝酸甘油介入三步９９ｍＴｃＭＩＢＩ 心肌显像对１２２ 例拟行ＰＴＣＡ 治疗的患者进行监测,并以术后１ ～２ 周的运动、静息显像作为疗效指标进行比较。结果：术前心肌显像显示的缺损变化与ＰＴＣＡ 疗效有重要关系。以运动与ＮＴＧ 显像组合反映的缺损变化作为预测指标,则与疗效指标呈正相关（ｒ ＝ ０ ．９３６６） 。结论：运动、静息、静滴硝酸甘油介入三步９９ｍＴｃＭＩＢＩ 心肌显像能够在术前全面准确地预测ＰＴＣＡ 的疗效。     

~（99m）Tc－MIBI门控平面心肌显像评价心肌梗塞区存活心肌──与~（99m）Tc─MIBISPECT及~（18）F－FDGPET结果比较

为评价９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）平面门控心肌显像（ＥＧＰ）在心肌梗塞患者存活心肌判断中的准确性，对２１例心肌梗塞患者进行了静息ＥＧＰ、静息和运动９９ｍＴｃ－ＭＩＢＩ心肌单光子发射计算机断层（ＳＰＥＣＴ）显像及饥饿时静息１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电于发射计算机断层（ＰＥＴ）显像．在２１例患者共１０５个心肌节段中，有１５个节段运动ＳＰＥＣＴ半定量分析局部９９ｍＴｃ－ＭＩＢＩ放射性分布大于左室峰计数的８０％（即正常节段），从本研究中排除．其余９０个节段中有７７个节段ＰＥＴ显像ＦＤＧ摄取明显，１３个节段无ＦＤＧ摄取．以ＦＤＧＰＥＴ为标准，ＥＧＰ在存活心肌判断中的灵敏度和特异性分别为９６％和７７％，而静息ＳＰＥＣＴ的灵敏度及特异性分别为９６％及６９％．两种显像方法在存活心肌判断中差异无显著性，同时两者在心肌节段间计分比较中有良好的一致性（ｒ＝０．８６）．提示ＥＧＰ在存活心肌判断中与ＭＩＢＩＳＰＥＣＴ相似．     

大剂量硝酸甘油介入^99mTc—MIBI心肌SPECT判定存活心肌？…

目的：探讨大剂量硝酸甘油介入（大剂量硝充法）＾９９ｍＴｃ－ＭＩＢＩ心肌ＳＰＥＣＴ对存活心肌判定的价值。材料和方法：对４４例大剂量硝充组和３１例小剂量硝充组的心肌梗塞患者均行静息和硝充法心肌显像。     

^99mTc—MIBI心肌断层显像肺摄取的定量分析

为评价＾９９ｍＴｃ＝甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像肺摄取定量分析对判断左心功能障碍的价值，４２例对照和６５例冠心病患者１周内完成＾９９ｍＴｃ－ＭＩＢＩ周内完成＾９９ｍＴｃ－ＭＩＢＩ心肌ＳＰＥＣＴ显像和核素心室显像。结果：对照组ＬＨＲ运动较静息时低（Ｐ〈０．０１）；冠心病组ＬＨＲ运动和     

GIK介入^201Tl与^99mTc—MIBI心肌灌注断层显像判定陈旧性心肌梗…

为评价１０％葡萄糖２５０ｍｌ＋胰岛素５Ｕ＋氯化钾１０ｍｍｏｌ（ＧＩＫ）介入＾２０１Ｔｌ与＾９９ｍＴｃ－甲氧基异丁基异腈（ＭＩＢＩ）心肌灌注断层显像（ＳＰＥＣＴ）估测心肌梗塞病人存活心肌的可靠性，将＾２０１Ｔｌ或＾９９ｍＴｃ－ＭＩＢＩ加入ＧＩＫ溶液中，静脉滴注后行心肌ＳＰＥＣＴ，采用圆周剖面法进行了定量分析，以存活分数为判断指标，估测２８例陈旧性心肌梗塞病人的存活心肌。全部病人均进行了静态心肌，＾２     

硝酸甘油酯介入~(99m)Tc-MIBI心肌断层显像与多巴酚丁胺负荷超声心动图判定存活心肌的比较

为比较硝酸甘油酯（ＮＴＧ）介入９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌断层显像与小剂量多巴酚丁胺负荷超声心动图（ＤＳＥ）在判断急性心肌梗塞（ＡＭＩ）后病人存活心肌中的一致性，对３６例ＡＭＩ病人分别进行了ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像和小剂量（＜１０μｇ·ｋｇ－１·ｍｉｎ－１）的ＤＳＥ检查，所有检查均在病人入院后２～３周内完成。结果：在心肌静态显像示梗塞的１０９个节段中，ＮＴＧ显像４３个为存活节段，存活心肌检出率为３９％；在基础状态下超声心动图示梗塞的９４个节段中，ＤＳＥ检查３５个为存活节段，其存活心肌检出率为３７％，两者间差异无显著性（χ２＝０１０５，Ｐ＞００５）。在两法共同检出的９２个梗塞节段中，均存活的节段为２９个，均未存活的节段为４９个，两法的一致性为８４８％（７８／９２，Κ＝０６８）。因此，ＮＴＧ介入９９ｍＴｃＭＩＢＩ心肌断层显像与ＤＳＥ检查均为判断ＡＭＩ后病人存活心肌的安全、可靠的方法，两法具有良好的一致性。     

99mTc-MIBI硝酸甘油介入心肌显像预测PTCA治疗效果

目的 :预测经皮腔内冠状动脉成形术 (PTCA)的治疗效果。材料和方法 :2 7例患者在PTCA治疗前后分别进行静态和硝酸甘油 (NTG)介入99mTc MIBI心肌显像研究。结果 :PTCA治疗前 ,静态显像 83个稀疏或明显稀疏节段中 ,NTG介入后有 45个变为正常 ,其余大部分节段99mTc MIBI摄取量不同程度增加 ,静态 13个缺损节段中有 4个缺损范围缩小 ;PT CA治疗后 ,静态显像与PTCA治疗前NTG介入显像结果基本一致 ,NTG介入显像 ,又有 13个分布稀疏的节段变为正常。结论 :NTG介入99mTc MIBI心肌显像可以预测PTCA治疗效果 ;PTCA治疗后NTG介入显像有助于了解存活心肌状况。     

Segmental analysis of SPECT 99mTc-methoxy isobutyl isonitrile and 201Tl myocardial imaging in ischaemic heart disease

To study the potential usefulness of 99mTc-methoxy isobutyl isonitrile (99mTc-MIBI) as a substitute for 201Tl in assessing patients with ischaemic heart disease, 24 patients underwent 1 day rest and exercise 99mTc-MIBI single photon emission computerised tomography (SPECT) 1 week after SPECT exercise 201Tl. All patients were catheterized within 1 month after myocardial imaging. In 17 patients, resting first pass radionuclide angiography (FPRNA) was performed with 99mTc-MIBI. The heart to lung ratio for 99mTc-MIBI and 201Tl was calculated both at rest and exercise. The segmental analysis for myocardial perfusion reveals that 87/96 segments (91%) were correctly classified by SPECT 201Tl and 84/96 segments (88%) were correctly classified by 99mTc-MIBI. A significant correlation was present between LVEF measured by 99mTc-MIBI FPRNA and contrast ventriculography (r = 0.85, P less than 0.0001). The heart to lung ratio both at rest and exercise for 99mTc-MIBI is significantly higher than 201Tl (P less than 0.01 and less than 0.001 respectively). We conclude that 99mTc-MIBI is a promising agent for simultaneous evaluation of myocardial perfusion and cardiac function.     

^99mTc—MIBI提前显像在心肌梗塞诊断中的应用

目的：探讨99mTc-MIBI心肌显像能否成为急性心肌梗塞的快速诊断手段。资料和方法：选择临床确诊的心肌梗塞患者35例，于注射99mTc－MIBI后10min与60min以相同条件分别进行SPECT显像，并以相同条件分析处理图像，记录心肝肺的放射性计数率，比较两次显像结果的差异。结果；10min像阳性率31.2％，60min像为308％，符合率95.2％。有22个节段（4．8％）两次显像缺损程度有差异，以下后壁居多（13／22.59.1％）。图像质量以60min像为佳，心脏计数率随时间延长而降低，而心肝比、心肺比升高。结论：10min显像与60min显像在本组病例中具有很好的诊断一致性，至少可为急性心梗提前50min提供诊断，可望成为急性心梗的一种快速诊断手段。     

Transient prolonged stunning induced by dipyridamole and shown on 1- and 24-hour poststress 99mTc-MIBI gated SPECT.

We investigated whether poststress gated SPECT, which was believed to show resting wall motion, revealed stunning induced by dipyridamole stress. METHODS: In 62 patients with coronary artery disease (n = 57) or chest pain (n = 5), dipyridamole stress gated 99mTc-hexakis-2-methoxyisobutyl isonitrile (MIBI) SPECT and rest 201Tl SPECT were performed on the first day; 24-h delayed 201Tl SPECT and rest gated 99mTc-MIBI SPECT were performed on the second day. Stress and rest gated 99mTc-MIBI SPECT was performed 1 h after injection. The myocardium was divided into 17 segments, and perfusion was scored on a 4-point scoring system (scores, 0-3 for normal to defect); wall motion during first-day poststress gated and second-day rest gated SPECT was also scored on another 4-point scale (scores, 0-3 for normal to dyskinesia). RESULTS: Thirty-one of 62 patients showed wall motion abnormality that was worse after stress than during resting. Three hundred eight (29%) of the total 1054 segments showed wall motion abnormality on poststress gated SPECT. In 198 of these segments, wall motion abnormality was the same on poststress and rest gated SPECT, and 106 segments showed wall motion that was worse on 1-h poststress than on rest gated SPECT. Perfusion was normal either during rest (n = 113) or after a 24-h delay (n = 18) in 131 segments with the poststress wall motion abnormality. Of these 131 segments, 69 showed the same wall motion abnormality between poststress and resting periods (persistent stunning). However, in 40 segments, abnormal wall motion on 1-h poststress gated SPECT normalized on rest gated SPECT (transient prolonged stunning). The other 20 segments showed improvement of wall motion during rest compared with the poststress period but still showed abnormal wall motion during the resting period (between transient prolonged stunning and persistent stunning). Stress perfusion decrease was more severe in transient prolonged stunning than in persistent stunning. Poststress wall motion abnormality was more severe in persistent stunning. CONCLUSION: Using gated 99mTc-MIBI SPECT, stunned myocardium was found on 1-h poststress SPECT compared with normal resting wall motion found on rest gated SPECT on the next day. We conclude that some myocardial walls did not show true resting wall motion on 1-h poststress gated SPECT; hence, caution is necessary when using wall motion on 1-h poststress gated SPECT to assess resting wall motion.     

急性心肌梗塞面积与心功能的关系

目的定量分析急性心肌梗死面积与心功能的关系。材料和方法初发急性穿壁心肌梗死患者,再通组15例,平均年龄57.7岁,未通组19例,平均年龄61.7,在发病早期和发病3周行SPECT显像,并于发病3周行核素左心室造影测量心肌缺血范围和LVEF。结果再通组第2次心肌显像心肌缺损范围显著小于第1次显像,未通组两次心肌显像,心肌缺损范围无显著差别,两组病例第2次心肌显像,再通组心肌缺损范围显著小于未通组,而LVEF显著高于未通组第2次心肌显像,心肌缺损范围与LVEF呈负相关性。结论早期血管再通可缩小心肌梗死面积,心肌梗死面积与左室射血分数有负相关性。     

201Tl and 99mTc-MIBI gated SPECT in patients with large perfusion defects and left ventricular dysfunction: comparison with equilibrium radionuclide angiography.

Left ventricular ejection fraction (LVEF) is a major prognostic factor in coronary artery disease and may be computed by 99mTc-methoxyisobutyl isonitrile (MIBI) gated SPECT. However, 201Tl remains widely used for assessing myocardial perfusion and viability. Therefore, we evaluated the feasibility and accuracy of both 99mTc-MIBI and 201Tl gated SPECT in assessing LVEF in patients with myocardial infarction, large perfusion defects and left ventricular (LV) dysfunction. METHODS: Fifty consecutive patients (43 men, 7 women; mean age 61 +/- 17 y) with a history of myocardial infarction (anterior, 26; inferior, 18; lateral, 6) were studied. All patients underwent equilibnum radionuclide angiography (ERNA) and rest myocardial gated SPECT, either 1 h after the injection of 1110 MBq 99mTc-MIBI (n = 19, group 1) or 4 h after the injection of 185-203 MBq 201Tl (n = 31, group 2) using a 90 degrees dual-head camera. After filtered backprojection (Butterworth filter: order 5, cutoff 0.25 99mTc or 0.20 201Tl), LVEF was calculated from reconstructed gated SPECT with a previously validated semiautomatic commercially available software quantitative gated SPECT (QGS). Perfusion defects were expressed as a percentage of the whole myocardium planimetered by bull's-eye polar map of composite nongated SPECT. RESULTS: Gated SPECT image quality was considered suitable for LVEF measurement in all patients. Mean perfusion defects were 36% +/- 18% (group 1), 33% +/- 17% (group 2), 34% +/- 17% (group 1 + group 2). LVEF was underestimated using gated SPECT compared with ERNA (34% +/- 12% and 39% +/- 12%, respectively; P = 0.0001). Correlations were high (group 1, r= 0.88; group 2, r = 0.76; group 1 + group 2, r = 0.82), and Bland-Altman plots showed a fair agreement between gated SPECT and ERNA. The difference between the two methods did not vary as LVEF, perfusion defect size or seventy increased or when the mitral valve plane was involved in the defect. CONCLUSION: LVEF measurement is feasible using myocardial gated SPECT with the QGS method in patients with large perfusion defects and LV dysfunction. However, both 201Tl and 99mTc-MIBI gated SPECT similarly and significantly underestimated LVEF in patients with LV dysfunction and large perfusion defects.     

99mTc-MIBI myocardial perfusion imaging in myocarditis

Myocardial perfusion imaging with technetium-99m-labelled methoxyisobutyl isonitrile single photon emission computed tomography (99mTc-MIBI SPECT) has proven to be an important clinical procedure in assessing the severity of myocardial ischaemia. The uptake and clearance of 99mTc-MIBI by the myocardium is affected by cell viability and membrane integrity. Consequently, infectious diseases, such as myocarditis, may also affect myocardial perfusion by inducing local inflammation and necrosis. We compared 99mTc-MIBI myocardial perfusion imaging with other heart monitoring methods in order to assess its value in the diagnosis of children with Coxsackie viral myocarditis. We examined 46 patients (age, 3-12 years) with Coxsackie viral myocarditis using 99mTc-MIBI myocardial perfusion imaging and compared the perfusion data with myocardial enzymes, electrocardiographic findings and echocardiography. Regions of hypoperfusion were found in all 46 patients. Seventeen patients (37%) showed two or more areas of diminished perfusion. Myocardial hypoperfusion was mild-to-moderate (<30%) in 33 (72%) patients and severe (>30%) in 13 (28%) patients. Characteristic creatine-kinase isoenzyme (CK-MB) increases, ST-T segment changes and diminished heart function were significantly correlated with reduced myocardial perfusion (all comparisons P<0.05). The results of this study suggest that the presence of myocardial uptake of 99mTc-MIBI may be a marker of myocardial inflammation and necrosis. All 46 patients with Coxsackie viral myocarditis showed a certain degree of reduced perfusion. When the perfusion findings were compared with other parameters, it was shown that myocardial enzyme levels, ST-T segment changes and left ventricular function correlated well with the 99mTc-MIBI-established perfusion defect severity. 99mTc-MIBI SPECT imaging is therefore helpful in providing additional diagnostic information in patients with Coxsackie viral myocarditis.     

The effect of aminophylline administration on 99mTc-MIBI lung and liver uptake in patients with or without myocardial ischemia

This work aims to analyze the influence of aminophylline in the pulmonary and hepatic uptake of 99mTc-methoxyisobutil isonitrile (99mTc-MIBI). 72 patients were studied and a myocardial perfusion (MPS) single photon emission computed tomography (SPECT) with 99mTc-MIBI was carried out after the administration of dipyridamole. According to the MPS, the patients were classified into 2 groups: Group A: 45 patients without myocardial ischemia and Group B: 27 with ischemia. Each group was divided into 2 subgroups according to whether they had (I) or had not (II) received intravenous aminophylline. The dipyridamole was administered for 4 minutes at a dose of 0.56 mg/kg. If the patients presented any complication, intravenous aminophylline was administered. At 30 minutes p.i., planar images were obtained during a scintigraphy in the interior projection after the injection of 99mTc-MIBI. The regions of interest in the heart, hepatic cupula, and most active area of the left lung were outlines and the activity rates were calculated: lung/heart (LHR) and liver/heart (LivHR). No statistically significant differences were observed in the uptake of 99mTc-MIBI between subgroups I and II. However, the LHR rates in both subgroups were significantly lower in the patients with normal myocardial perfusion than in the patients with ischemia: LHR group A1 vs B1: 0. 32 +/- 0.08 vs 0.36 +/- 0.06, p = 0.03; group AII vs BII 0.31 +/- 0. 07 vs 0.35 +/- 0.07, p = 0.01 respectively. In conclusion, the administration of aminophylline, after the infusion of dipyridamole for MPS, does not modify the pulmonary or hepatic uptake of 99mTc-MIBI.     

99mTc-MIBI心肌灌注显像在心肌缺血治疗中的指导意义

目的确定~(99m)Tc-MIBI心肌灌注显像在心肌缺血治疗中的指导意义。方法利用美国GE公司生产的双探头可变角SPECT检查了86例冠状动脉供血不足引起的心肌缺血患者,并对其中48例心肌灌注治疗前后的缺损填充或改善情况进行了观察。结果43例(89.6%)患者显像缺损填充或有明显改善,仅1例缺损填充不佳。结论~(99m)Tc-MIBI心肌灌注显像在心肌缺血治疗中有重要指导意义。