铊-201负荷心肌洗脱率评价心肌缺血与冠状动脉血流储备的对比研究

目的　评价铊 2 0 1( 2 0 1 Tl)负荷心肌洗脱率在心肌缺血方面的应用价值 ,观察2 0 1 Tl负荷洗脱率与冠状动脉 (冠脉 )血流储备的相关性。方法　选择经冠脉造影证实的冠心病 (冠脉狭窄≥ 5 0 % )住院患者 2 5例 ,另外 2 3例经冠脉造影检查显示冠脉正常或狭窄 <5 0 %者作为对照组。行2 0 1 Tl双嘧达莫 (潘生丁 )负荷心肌显像检查 ,处理出靶心图后 ,计算局部室壁洗脱率。洗脱率 =(负荷态放射性计数 -延迟态放射性计数 ) 负荷态放射性计数× 10 0 %。在核素检查前后两周内行冠脉造影及冠脉内多普勒血流测定。结果　冠脉狭窄组室壁洗脱率显著低于对照组 [前壁 ( 2 6 89± 4 39) %vs ( 4 3 5 4± 9 0 8) % ;下壁 ( 16 81± 6 13) %vs ( 4 5 0 4± 9 6 6 ) % ;侧壁 ( 2 7 76± 9 0 1) %vs ( 4 3 87± 9 17) % ,P <0 0 0 1];冠脉狭窄组所测冠脉血流储备 (CFR =充血相平均峰值流速 静息相平均峰值流速 )值显著低于对照组CFR( 1 6 7± 0 6 3vs 2 85± 0 6 4 ,P <0 0 0 1) ;前壁洗脱率与前降支狭窄程度的相关性、侧壁洗脱率与回旋支狭窄程度的相关性差 (r =- 0 4 6 9,P =0 0 5 ;r =- 0 394 ,P =0 16 4 ) ;但下壁洗脱率与右冠脉狭窄程度之间的相关性较好 (r=- 0 6 6 1,P =0 0 0 5 ) ;室壁洗脱率与     

小剂量多巴酚丁胺核素心室造影与^201铊再注射心肌显像对…

采用小剂量多巴酚丁胺（Ｄｏｂ）负荷试验与核素心室造影（ＲＮＶ）相结合的方法（ＤｏｂＲＮＶ）对２０例陈旧性心肌梗塞（ＯＭＩ）患者进行存活心肌的评估并与＾２０１铊（Ｔｌ）再注射心肌以显像（ＳＰＥＣＴ）相比较。结果显示：静态ＲＮＡ明显地低估存活民肌的程度，ＤｏｂＲＮＶ将静态ＲＮＶ对存活心肌的检出率增加６１．５％。以＾２０１Ｔ１再注射心肌ＳＰＥＣＴ为标准，ＤｏｂＲＮＶ检测存活心肌的阳性预测率为９３．８％，     

运动负荷201铊单光子发射型计算机断层显像判断经皮冠状动脉腔内成形术后再狭窄的价值

目的 :探讨运动负荷 2 0 1铊 (2 0 1 Tl)单光子发射型计算机断层显像 (Ex- 2 0 1 Tl SPECT)判断经皮冠状动脉腔内成形术(PTCA)后再狭窄的价值。　　方法 :对 PTCA术后 3～ 6个月的 12 8例患者 (心绞痛 74例 ,陈旧性心肌梗塞 5 4例 )进行 Ex- 2 0 1 Tl SPECT及运动负荷心电图 (Ex- ECG)。将左心室划分为 9个节段 ,采用 4级评分法对 2 0 1 Tl分布进行视觉评价 ,比较延迟像与负荷像的核素分布。　　结果 :12 8例冠心病患者 ,Ex- 2 0 1 Tl SPECT判断冠状动脉再狭窄的敏感性及特异性分别为 79%、89% ,明显高于 Ex-ECG(Ex- ECG 为 5 9%、6 8% ,Ex- ECG 为 5 2 %、74% ) ;心肌梗塞患者的 Ex- 2 0 1 Tl SPECT敏感性明显高于 Ex- ECG (P<0 .0 1) ,其特异性无显著差别。冠状动脉再狭窄程度越重 (狭窄 <10 0 % ) ,其检出率越高。　　结论 :Ex- 2 0 1 Tl SPECT使心肌显像对判断 PTCA术后再狭窄具有较大的临床应用价值。     

^201Tl静息—再分布显像后行再注射心肌断层显像检测存活心肌的价值

为评价＾２０１Ｔｌ静息－再分布显像后行再注射显像检测存活心肌的价值,对２４例心肌梗死患者行＾２０１Ｔｌ静息再分布－再注射显像。８例经皮穿刺腔内冠状动脉成形术（ＰＴＣＡ）的患者术前及术后２周￣４周随访了超声心动图,结果显示＾２０１Ｔｌ静息显像有９７个心肌节段放射性摄取异常,其中４ｈ再分布显像有可逆性灌注缺损３１个节段,再注射显像均为可逆性缺损,再分布显像为不可逆性灌注缺损的６６个节段,其中９个节段（     

冠状动脉造影与运动负荷心肌灌注显像诊断冠心病的对比分析

目的 :比较冠状动脉造影 (CAG)和运动负荷心肌灌注显像对诊断冠心病 (CHD)的作用。方法 :2 35例患者在 1个月内进行了CAG和运动负荷99mTc MIBI心肌灌注单光子发射计算机断层显像 (SPECT)检查。CAG在主要血管及分支病变狭窄≥ 5 0 %为阳性 ;心肌灌注检查将左室分为 16个节段 ,运动态和静息态相比较 ,存在放射性缺损或填充为阳性。结果 :2 35例中CHD170例 ,其他心脏病 4 3例 ,无器质性心脏病 2 2例。 170例CHD中 ,16 8例CAG阳性 ,16 2例运动SPECT阳性。 4 3例其他心脏病中 13例运动SPECT阳性 (30 .2 % )。 2 2例无器质性心脏病病例中 3例运动SPECT阳性 (13.6 % )。在CHD的诊断中 ,CAG的敏感性为 98.8% ;运动SPECT敏感性为95 .3% ,特异性为 86 .4 %。结论 :在临床工作中 ,CAG和运动SPECT均为诊断CHD的有效手段。由于后者的无创性 ,易于重复 ,是临床随访的较好方法。但在其他心脏病患者 ,运动SPECT阳性率可达 30 .2 % ;在无明显心脏疾病者可达 13.6 %。因此 ,临床上有必要鉴别运动SPECT阳性的非CHD患者     

冠状动脉旁路术前存活心肌的评价(附13例报告)

目的对１３例准备行冠状动脉旁路术（ＣＡＢＧ）的冠心病患者术前行硝酸异山梨酯（ＩＳＤＮ）介入２０１ＴＩ心肌断层显像，评价其检测存活心肌及预测心功能恢复的价值。方法ＣＡＢＧ术前患者于多巴酚丁胺负荷高峰时注射２０１ＴＩ行负荷、３小时再分布心肌显像后，静脉点滴ＩＳＤＮ并再次注射２０１ＴＩ（ＩＳＤＮ／ＲＩ）进行心肌显像，ＣＡＢＧ术后３个月复查静态心肌显像，并比较术前后左室射血分数。结果１３例患者负荷像共有４８个节段灌注异常，ＩＳＤＮ／ＲＩ显像后有２９个节段灌注改善，其中２６个节段在术后心肌灌注亦有改善；不可逆灌注或异常加重的１９节段中，术后仍有１７个节段灌注无改善，ＩＳＤＮ／ＲＩ显像检测存活心肌的准确性为８９．５％。且左室射血分数的提高与ＩＳＤＮ／ＲＩ显像可逆灌注节段数密切相关（ｒ＝０．７３，Ｐ＜０．００５）。结论ＩＳＤＮ／ＲＩ２０１ＴＩ心肌显像在估测存活心肌和预测心功能恢复方面有较高的临床实用价值。     

小剂量多巴酚丁胺核素心室造影与201铊再注射心肌显像对存活心肌评估的比较

采用小剂量多巴酚丁胺（Ｄｏｂ）负荷试验与核素心室造影（ＲＮＶ）相结合的方法（ＤｏｂＲＮＶ）对２０例陈旧性心肌梗塞（ＯＭＩ）患者进行存活心肌的评估并与２０１铊（Ｔｌ）再注射心肌断层显像（ＳＰＥＣＴ）相比较。结果显示：静态ＲＮＶ明显地低估存活心肌的程度，ＤｏｂＲＮＶ将静态ＲＮＶ对存活心肌的检出率增加６１．５％。以２０１Ｔ１再注射心肌ＳＰＥＣＴ为标准，ＤｏｂＲＮＶ检测存活心肌的阳性预测率为９３．８％，阴性预测率为８０％，预测准确率为８８．５％。     

冠状动脉介入治疗前后腺苷负荷心肌核素显像的临床意义

目的探讨腺苷负荷心肌核素显像对于冠状动脉介入治疗的临床意义。方法冠心病可疑患者住院,行腺苷负荷心肌核素显像和冠状动脉造影,根据需要进行介入治疗,介入治疗后3~7天复查腺苷负荷心肌核素显像。腺苷负荷心肌核素显像采用单光子发射断层显像图像采集系统,腺苷总量为840ΜG/KG,6分钟匀速静脉泵入,腺苷泵入3分钟时静脉推注99MTC-MIBI925MBQ,1·5小时后进行心肌断层显像。若异常,次日行静息心肌显像。核素显像左室心肌分为17个节段,心肌灌注分4级。结果63例冠心病患者,平均(63±10)岁,40例得到介入处理,其中28例患者冠状动脉介入处理后复查腺苷负荷心肌核素显像,介入后心肌核素血流灌注较介入前明显改善(P<0·01)。结论腺苷负荷心肌核素显像对于冠心病患者冠状动脉介入前病变分析以及介入后疗效判断有一定的临床意义。     

铊^201单光子发射计算机断层心肌显像对隐匿性冠心病预后判断的价值

目的探讨心肌潘生丁负荷／再分布铊（T1）^201单光子发射计算机断层显像（single photon emission computed tomography，SPECT）法评价隐匿性冠心病预后的可行性。方法入选1998至2005年期间94例无任何症状但运动平板试验反复阳性的飞行人员，根据SPECT心肌显像结果分为检查结果阳性组及阴性组，阳性组中根据心肌缺血累及范围又分为单个节段受累亚组、2个节段受累亚组和2个以上节段受累亚组，平均随访4．5年，比较组间的主要心血管事件（major adverse cardiovascular events，MACE）发生率。结果随访过程中，阳性组与阴性组的MACE分别为30％与7％，差异具有统计学意义（P〈0．01）。2个以上节段受累亚组组MACE发生率（100％）明显高于单个节段受累亚组（24％）、2个节段受累亚组（22％）及阴性组（7％），P均〈0．05。结论潘生丁负荷心肌T1^201-SPECT显像有助于隐匿性冠心病预后判断，从而指导临床早期干预治疗。     

The clinical role of thallium-201 scintigraphy in the management and prognosis of coronary artery disease

The clinical impact of thallium-201 (Tl-201) scintigraphy incoronary artery disease was reviewed in 162 consecutive patientsreferred for routine investigation. Normal TI-201 images wereobtained in 86 of the 102 studies undertaken for diagnosticpurposes. Eighty-one (94%) of the 86 were spared diagnosticcoronary arteriography; 5 proceeded to coronary arteriographyfor persistent symptoms (I had double vessel disease, 2 hadsingle vessel disease only, 2 had normal arteriograms). Conversely,coronary arteriography was normal in 2 of l6 patients (12.5%)with unequivocal image defects. Tl-201 scintigraphy was performed as a functional complementto coronary arteriography in 60 patients, influencing the decisionfor surgery in 36 and determining the presence or absence ofmyocardial ischaemia in 24 patients with equivocal coronaryarteriograms. Normal data were obtained in 9 patients. Of the95 patients with normal Tl-201 scintigrams, only 5 (5.2%) requiredfurther investigations or intervention (4 arteriograms, 1 coronaryangioplasty) over a follow-up period of 18 ± 1 months,none suffered myocardial infarction and none died. There wereno deaths in either the diagnostic or complementary group, irrespectiveof the result of the Tl-201 scintigram, during the mean follow-upperiod of 18 months. These data confirm both the valuable role of Tl-201 scintigraphyin the management of patients with suspected or proven coronaryartery disease and the excellent prognostic value of a normalTl-201 scintigram.     

Dobutamine stress echocardiography compared with dipyridamole thallium-201 single-photon emission computed tomography in detecting coronary artery disease

To compare the diagnostic value of dobutamine stress echocardiographywith dipyridamole thallium-201 single-photon emission computedtomography (SPECT) in detecting coronary artery disease (CAD),we performed both tests on 54 patients who also underwent coronaryarteriography. Dobutamine was infused at an incremental regimenof 5,10,20,30 and 40 µg. kg^-1. min^-1. Dipyridamole wasinfused at a rate of 0.14 mg. kg^-1. min^-1 over 4 min. Dobutaminestress echocardiography detected 40 (93%) and SPECT 42 (98%,P=ns) of the 43 patients with significant CAD, defined as (greaterthan or equal) 50% diameter stenosis. The specificity was 73%(8 of 11) for both tests. The sensitivity for detecting individualcoronary artery stenosis with dobutamine stress echocardiographywas 81% (30 of 37) for the left anterior descending artery,75% (24 of 32) for the right coronary artery, and 61% (17 of28) for the left circumflex artery. For SPECT it was 89%, 97%(P>0.05 vs dobutamine stress echocardiography) and 75%, respectively. Among the 97 stenotic coronary arteries, 17 had mild to moderatestenosis (50%-69% diameter stenosis) and 80 had severe stenosis($$70% diameter stenosis). With dobutamine stress echocardiography,53% of the arteries with mild to moderate stenosis were identifiedvs 78% of those with severe stenosis (P<0.05). With SPECT,the sensitivity was 82% (14 of 17) in mild to moderate stenosisand 89% (71 of 80) in severe stenosis (P=ns). No major sideeffects occurred during either test. Thus, both dobutamine stressand SPECT are highly sensitive for detection and localizationof CAD. However, the sensitivity of dobutamine stress is affectedby the level of stenosis severity.     

201铊断层显像对糖尿病患者并发冠心病诊断敏感性和特异性研究

目的 探讨放射性核素（201铊）心肌显像对糖尿病（DM）并发冠心病（CHD）患者的临床诊断价值。方法 将152例疑为CHD的患者分为DM组和非糖尿病（NDM）组，分别实施放射性核素（201铊）心肌显像和冠状动脉造影检查，计算两组患者放射性核素（201铊）心肌显像诊断的敏感性和特异性。结果 DM组放射性核素。“铊心肌显像诊断结果敏感性90％、特异性43％；NDM组敏感性83％、特异性67％。DM组与NDM组结果比较：敏感性差异无统计学意义，特异性差异存在统计学意义（P〈0．05）。结论 DM并发CHD患者的放射性核素（201铊）存在统计学心肌显像特异性低。     

Myocardial perfusion imaging in coronary artery disease

Radionuclide myocardial perfusion imaging (MPI) can be used to demonstrate the presence of coronary heart disease and to risk stratify and guide management of patients with known disease. It has the ability to localize hemodynamically important coronary stenoses, and assess the extent and severity of coronary obstruction by the presence and extent of perfusion defects. A normal stress MPI indicates the absence of coronary obstruction and hence of clinically significant disease. Cardiac PET has the advantage from SPECT of higher spatial and temporal resolution, and a decreased radiation exposure to patients. Hybrid cardiac imaging combining SPECT or PET with CT data appears to offer superior diagnostic and prognostic information in patients with intermediate risk for CAD. A significant progress in better quantification of myocardial blood flow and coronary flow reserve has recently been seen. Also several studies have demonstrated that the combination of imaging apoptosis and matrix metalloproteinases production can help imaging vulnerable plaque and identifying the group of high-risk asymptomatic patients who will benefit most by an imaging procedure.     

Noninvasive assessment of coronary artery bypass patency: Determination of myocardial thallium-201 washout rates*

This prospective study was undertaken to investigate the responseof thallium-201 washout rates to coronary artery bypass surgery.Thirty-four patients with coronary heart disease were studiedbefore and after coronary artery bypass grafting, 27 patientswith normal coronary arteries serving as controls. All patientsunderwent cardiac catheterization and thallium-201 serial imaging,including assessment of myocardial washout rates. Pre-operatively,thallium-201 washout rates yielded a considerably higher sensitivityin detection of coronary artery disease, without significantloss of specificity compared to qualitative evaluation of serialstatic thallium-201 scintigrams. Post-operatively, 50 of 57segments supplied by a patent graft showed normal washout rates,while in 9 out of 11 segments an occlusion of the graft wasindicated by decreased washout rates. Compared to pre- and post-operativequalitative interpretation of static thallium-201 images, thepostoperative assessment of washout rates increased both sensitivity(82% vs. 64%) and specificity (88% vs. 77%) for the evaluationof bypass graft patency. Thus, quantitative assessment of thallium-201washout rates improves the diagnostic reliability of noninvasivedetection of myocardial ischaemia with regard to the evaluationof coronary artery bypass graft patency.     

Atrial pacing and thallium-201 scintigraphy in patients with chest pain: correlation with coronary anatomy

Atrial pacing and thallium-201 scintigraphy were performed in 72 patients referred for evaluation of chest pain. Coronary artery disease (CAD) was present in 63 patients, as documented by cardiac catheterization performed at the same time or within 2 months of atrial pacing. Nine patients had no or insignificant (less than 50% stenosis) CAD. The sensitivity of pacing-induced angina for CAD was 51%, and was 49% for ST depression. Specificities were 89% and 78%, respectively. A reversible perfusion defect was seen in 54% of patients with CAD (specificity 89%), and a fixed defect in 29% (specificity 100%). The sensitivity of an abnormal thallium-201 scan (one or more reversible or fixed defects) was 79% (p less than 0.05 compared to angina or ST depression). Combined sensitivity of ST depression and/or an abnormal thallium-201 scan was 87%. There were no significant changes in any of these sensitivities as the number of vessels with CAD increased. Thallium-201 scintigraphy correctly identified 11 of 19 (58%) patients with single-vessel disease as having CAD in only one vessel, but underestimated the extent of disease in all but a few patients with multivessel disease. The sensitivity of perfusion imaging to identify lesions in specific vessels ranged from 27% (circumflex) to 57% (right coronary artery). Specificities were 100% for circumflex, 78% for anterior descending, and 83% for right coronary artery lesions.(ABSTRACT TRUNCATED AT 250 WORDS)