核素—运动心肌灌注显像在心肌梗塞病人中的应用

无并发症的急性心肌梗塞病人在出院前做核素－次极量运动心肌灌注显像对估计预后十分重要，此检查使临床医生能分析某一特定区域的心肌血供，客观评估残余缺血的范围和程度，区梗塞区内及区外缺血，弥补冠状动脉造影仅提供血管解剖病变的局限性。     

心肌灌注显像诊断隐匿性心肌缺血

~(201)铊闪烁显象检测心肌缺血的敏感性较心电图运动试验为强,灌注缺损的发生率较心电图ST段压低为高且出现在心绞痛之前。~(201)铊闪烁显像可鉴别无心绞痛者心电图运动试验是真阳性还是假阳牲。锝标记异腈显像提高了心肌灌注显像的精确性。     

运动负荷核素心肌灌注显像对冠心病的诊断价值

目的探讨运动负荷核素心肌灌注显像对冠心病的诊断价值。方法对117例疑有冠心病者,以冠状动脉造影（CAG）结果作为诊断标准,进行心电图平板活动试验和运动负荷核素心肌灌注断层显像两种检查,并将结果行对比分析。结果与CAG结果比较,心电图平板活动试验诊断冠心病的敏感性为60%,特异性为73%;运动负荷核素心肌灌注显像诊断冠心病的敏感性为87%,特异性为69%。结论运动负荷核素心肌灌注显像与心电图平板活动试验比较,敏感性高,特异性相近,对冠心病的无创性诊断具有重要价值。     

潘生丁核素心肌灌注显像在X综合征中的应用

核素心肌灌注显像已广泛用于冠心病患者的临床评价 ,本文报告 X综合征 44例应用潘生丁心肌灌注显像 ,现将结果报告于下。1　资料与方法1 .1　临床资料1 .1 .1　 X综合征患者 44例 ,其中男 2 0例 ,女 2 4例 ,年龄 42～ 60岁 (平均 5 2 .9± 8.2岁 ) ,所有病例符合下列诊断标准 [1] :1有典型劳累性心绞痛发作 ;2有心肌缺血依据 ,包括静息或负荷心电图运动试验阳性 ( ST段下移≥ 1 mm) ;3冠状动脉造影阴性 ;4无冠状动脉痉挛 ;5排除可导致心电图缺血改变的其它心脏病。1 .1 .2　对照组 :选择临床有典型心绞痛症状 ,并经冠状动脉造影 (冠脉造影…     

核素心肌灌注显像和踏车运动试验对老年人冠心病的诊断价值

目的 探讨核素心肌灌注单光子发射计算机断层显像(SPECT)和踏车运动试验(ET)对老年人冠心病的诊断价值。方法 选取曾进行冠状动脉造影(CAG)、且于造影前后2个月内完成SPECT和ET的老年人，对其检查结果进行回顾性分析。将静息时SPECT的结果以心肌缺血程度和范围进行评分。计算ET心电图的最大ST／HR斜率(max ST／HR)。结果 以CAG结果作为金标准，114例患者中有89例确诊为冠心病，25例排除冠心病。SPECT的敏感性和特异性分别为92．1％和60．0％，ET则分别为60．7％和72．0％。以max ST／HR≥2．2μV／bpm作为判别标准，可以将冠心病诊断的敏感性和特异性分别提高至80．9％和80．0％。以SPECT评分和ET的max ST／HR作为诊断指标，获得受试者工作曲线(ROC曲线)。两条曲线形态不同，但是ROC曲线下面积差异无显著性。结论 SPECT评分和ET的max ST／HR都是较好的冠心病检测指标。对sPEcT和ET的结果进行细致评价可以提高老年人冠心病诊断的准确率。     

核素心肌灌注显像对糖尿病微血管病变诊断的临床应用价值

目的 研究核素心肌灌注显像对诊断糖尿病(DM)微血管病变患者心肌缺血及预后评价的价值. 方法 97例住院患者,其中男64例,女33例,经临床证实均为有不同程度心绞痛的DM微血管病变患者,冠状动脉造影(CAG)检查均为阴性(无异常和血管狭窄<50%),年龄45～85(57±13)岁.予核素心肌灌注显像,并对患者预后进行抽样临床随访. 结果 核素心肌灌注显像阳性、CAG阴性76例,核素心肌灌注显像与CAG均阴性21例.其中核素心肌灌注显像阳性患者预后均较阴性者差,其心脏事件发生率与缺血面积及严重程度呈正相关. 结论核素心肌灌注显像对DM微血管病变的诊断和预后评价有重要意义.     

核素心肌灌注显像与反向再分布

反向再分布(reverse redistribution)足指心肌灌注显像早期(静息或运动)灌注正常的部位,晚期显像则出现灌注异常,或者原来灌注异常的部位,晚期显像进一步恶化的现象.1979年,Tanasescu等首先报道了这一现象,以后的研究则进一步将前者称为A型,后者称为B型.多年以来,虽然研究对反向再分布进行了大量的研究,但其发生机制和临床意义至今尚无定论.     

硝酸甘油介入~(99m)Tc-甲氧基异丁基异腈心肌灌注断层显像评估存活心肌

目的　评估静息及硝酸甘油介入99mTc 甲氧基异丁基异腈 (99mTc MIBI)心肌灌注断层显像在存活心肌检测中的应用价值。方法　对心肌梗死 2 0例于血管重建术前分别行静态及硝酸甘油介入显像 ,血管重建术后 1个月重复静息心肌显像并进行对比分析。结果　 2 0例共有 1 4 4个异常灌注的心肌节段 ,硝酸甘油介入后有 72个心肌节段灌注改善 ,血管重建术后有 77个心肌节段灌注改善。硝酸甘油介入改善的 72个节段术后有 62个节段改善 ;而术前无改善的 72个节段术后只有 1 5个节段改善 ,硝酸甘油介入99mTc MIBI心肌灌注显像对存活心肌预测的阳性预测值为 86 .1 % ,阴性预测值为 79.2 % ,预测准确率为 82 .6%。结论　硝酸甘油介入99mTc MIBI心肌灌注断层显像是可供临床检测心肌存活的安全、有价值的方法     

腺苷负荷试验心肌灌注显像对冠心病的诊断价值

目的:分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点,评价其诊断冠心病的临床价值.方法:对68例临床疑诊冠心病患者,将其腺苷负荷试验心肌灌注显像结果与冠状动脉造影(CAG)结果进行对比分析.结果:在68例患者中,36例CAG阳性,其中腺苷心肌灌注显像检出病变33例(91.7%),未检出病变3例(8.3%);32例CAG阴性,其中腺苷心肌灌注显像异常3例(9.4%),正常29例(90.6%);腺苷心肌灌注显像对冠心病诊断的敏感性92.3%,特异性90.6%.结论:腺苷核素心肌灌注显像诊断冠心病敏感性及特异性均较高,是协助诊断冠心病的有效的无创性检查方法.     

~(99m)Tc-MIBI门控心肌灌注断层显像检测冠心病的准确性

目的　评价 99m Tc- MIBI门控心肌灌注断层显像估价冠心病 (CAD)的准确性 ,以及门控心肌灌注断层显像显示心肌损害与冠脉造影的关系。方法　对 93例受检者进行了运动 /静息 99m Tc- MIBI门控心肌灌注断层显像 ,其中 47例有冠脉造影检查 ,冠状动脉狭窄 >50 %为 CAD诊断标准。结果　检测 CAD的灵敏度为 84.84% ,特异性为 85.71 % ,准确性为 92 .0 0 %。正常人组的正常符合率 94%。检测 LAD病变的灵敏度为84.62 % ,LCX为 77.77% ,RCA为 85.71 %。检测 L AD病变的准确性 79% ,LCX为 77% ,RCA为 82 %。 1 2例冠脉造影显示 50 %～ 70 %狭窄者与心肌灌注显像的相关性较差 (r=0 .33,P=NS)。 2 1例冠脉造影显示 >70 %狭窄者与心肌灌注显像有良好的相关性 (r=0 .0 5,P<0 .0 5)。结论　 99m Tc-MIBI门控心肌灌注断层显像可以准确地检测冠心病 ,在避免冠脉造影检查风险方面 ,对老年病人更有实际应用价值     

99mTc-MIBI甲状旁腺显像及99mTc-MDP全身骨显像综合判断甲状旁腺功能亢进

目的　比较９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ双时相法与 Ｍ Ｉ Ｂ Ｉ９ ９ ｍ Ｔｃ Ｏ４ － 图像相减法两种显像法对甲状旁腺功能亢进（ 甲旁亢） 的诊断价值，同时结合９ ９ ｍ Ｔｃ Ｍ Ｄ Ｐ 全身骨显像综合判断甲旁亢患者的病情。方法　对１８ 例甲旁亢患者进行静注９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ７４０９２５ Ｍ Ｂｑ ，分别在第１５ 分钟、第２ 小时作颈前位平面显像；显像结束后立即予床边静注９ ９ ｍ Ｔｃ Ｏ４ － ７４１１１ Ｍ Ｂｑ ，１５ 分钟后再作显像。以９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ 延迟显像图减去９ ９ ｍ Ｔｃ Ｏ４ － 显像图，获得 Ｍ Ｉ Ｂ Ｉ９ ９ ｍ Ｔｃ Ｏ４ － 相减图。结果　９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ早 期 显 像（ 第１５ 分钟） 检 测甲旁亢病灶的灵敏度为６１ ．１ ％ （１１／１８） 、延迟相（２ 小时） 的灵敏度８３ ．３ ％ （１５／１８） 。１５ 例阳性显像中１４ 例为腺瘤，１ 例为癌；３ 例阴性者均为腺体增生。 Ｍ Ｉ Ｂ Ｉ９ ９ ｍ Ｔｃ Ｏ４ － 相减法除同样显示１５ 例９ ９ ｍ Ｔｃ Ｍ Ｉ Ｂ Ｉ 延迟显像的病灶外，也检出１ 例增生型甲旁亢病灶。全身骨显像结果，２ 例出现“棕色瘤”样病灶，１０ 例呈多灶性骨放射性异常集聚改变     

Adenosine Technetium-99m sestamibi (SPECT) for the early assessment of jeopardized myocardium after acute myocardial infarction

The purpose of this study was to evaluate the accuracy of adenosineTc-99m sestamibi single photon emission computed tomography(SPECT) in the detection of jeoparidized myocardium early afteracute myocardial infarction. Coronary arteriography and myocardialscintigraphy were performed in 50 consecutive patients withan uncomplicated myocardial infarction. Myocardium was consideredjeopardized if a significant infarct-related vessel stenosis(> 50% diameter stenosis) supplied an infarct area with residualviable tissue. Perfusion reversibility in the infarct regionoccurred in 25 patients (50%) and was almost solely observedin the presence of jeopardized myocardium. Non-reversible perfusion defects in the infarct region werefound in patients without jeopardized myocardium. This subgroupconsisted of either patients without significant vessel stenosisor patients without significant residual viability in the infarctregion. Adenosine Tc-99m sestamibi SPECT had an accuracy of88% for the detection of jeopardized myocardium. Side effectsduring adenosine infusion were frequently observed but welltolerated. These results suggest that adenosine Tc-99m sestamibi SPECTis an accurate non-invasive method for detecting jeopardizedmyocardium after acute myocardial infarction and may be a valuablenon-invasive test for the early selection of patients at riskfor future ischaemic events.     

Should imaging at stress always be followed by imaging at rest in Tc-99m MIBI SPECT?

Objectives. We addressed the question whether in patients with cardiac chest pain referred for stress myocardial perfusion scintigraphy, Tc-99m MIBI SPECT stress imaging should always be followed by a rest imaging procedure. Background. Using Tc-99m MIBI imaging a stress-rest sequence is usually performed implying that the resting study always follows the stress study irrespective of the results of the stress study. As a normal stress study would eliminate a subsequent resting study, it appears desirable to potentially define certain subsets of patients in whom a normal stress study can be expected in order to determine a more selective referral approach to the nuclear medicine department. The consequences of such a more streamlined approach would less impose on the logistics of the department of nuclear medicine, with decrease of investigation time, radiation dose, and costs in a time of retrenchment in the medical sector. Methods. A consecutive series of 460 patients (mean age 58.2 years) was studied who were stratified to 269 patients without prior myocardial infarction, and to 191 patients with documented evidence of a previously sustained mycoardial infarction. All patients underwent Tc-99m MIBI SPECT imaging according to a two-day stress-rest protocol. Results. Patients with and without a previous myocardial infarction showed suboptimal overall predictive accuracies for the exercise electrocardiograms (58% and 60%, respectively). In the total group of 460 patients, 94 (20%) patients showed a normal stress-rest Tc-99m MIBI SPECT; this occurred in 86/269 (32%) patients without a previous myocardial infarction and in only 8/191 (4%) patients with a previous myocardial infarction. Conclusions. Patients with a stress defect at Tc-99m MIBI SPECT imaging should always undergo a resting SPECT study irrespective of the clinical and stress electrocardiographic findings. As patients without a previous myocardial infarction had a normal stress SPECT study in almost one-third (32%) of patients compared to only 4% in patients with a previous myocardial infarction, it may be useful to employ different referral and imaging strategies i.e. a stress-only versus a stress-rest procedure. To schedule referring patients differently according to the presence or absence of a previously sustained myocardial infarction may be cost-saving, less demanding for the nuclear medicine personnel, and patient-convenient. In addition, a stress-only imaging procedure reduces radiation exposure to the individual patient.     

Tc-99m ciprofloxacin imaging in acute cholecystitis

AIM: To evaluate the eff icacy of a new nuclear imaging Infecton (Tc-99m ciprofloxacin) for the diagnosis of acute cholecystitis. METHODS: Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic f indings. RESULTS: The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative. This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%, and a negative-predictive value of 75%. CONCLUSION: Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.     

Tc-99m ciprofloxacin imaging in acute cholecystitis

AIM To evaluate the efficacy of a new nuclear imaging Infecton (Tc-99m ciprofioxacin) for the diagnosis of acute cholecystitis.METHODS Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic findings.RESULTS The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative.This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%,and a negative-predictive value of 75%.CONCLUSION Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.     

Tc-99m ciprofioxacin imaging in acute cholecystitis

AIM: To evaluate the efficacy of a new nuclear imaging Infecton (Tc-99m ciprofioxacin) for the diagnosis of acute cholecystitis.METHODS: Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic findings.RESULTS: The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative.This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%,and a negative-predictive value of 75%.CONCLUSION: Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.     

犬心肌梗死再灌注前后血清CPK变化及~(99m)Tc-MIBISPECT改变

目的　探讨评估心肌梗死 (MI)范围及再灌注效果的方法。方法　制成 1 8只犬冠状动脉左前降支人工狭窄模型 ,随机分为3组 ,每组 6只 ,Ⅰ组犬为冠状动脉结扎 1 5h再灌注组 ,Ⅱ、Ⅲ组分别为犬冠状动脉结扎 3 0h、6 0h再灌注组。在冠状动脉结扎前 ,结扎90min及再灌注 2 4 0min测定 1 8只犬血清CPK并进行犬I再灌注前后99mTc MIBISPECT显像。结果　犬冠状动脉结扎后血清CPK升高 ,再灌注后Ⅰ、Ⅱ组CPK升高明显 ,Ⅲ组犬CPK升高不明显。犬梗死心肌99mTc MIBISPECT显像的放射性缺损节段分别有 33 3 %、30 0 %、1 1 1 %的节段在再灌注99mTc MIBISPECT显像中出现放射性填充 ,MI再灌注后 ,Ⅰ、Ⅱ、Ⅲ组犬的心肌放射性分布得分亦降低。结论　MI灌注后CPK反映心肌损伤程度的准确性较差 ,99mTc MIBISPECT显像是了解MI范围及再灌注效果的较好手段