再注射铊201方法鉴别冬眠与梗塞心肌的探讨

Use of Reinjection Thallium 201 Imaging for the Differentiation of Viable from Infarction Myocardium

  • 摘要: 本文通过PET应用铊201再注射晚期显象法,研究24例心梗患者,探讨发现冬眠心肌的灵敏度。24例共216节段,运动后有127段铊201灌注缺损(58.7%)。4小时不可逆而72h≥1个节段可逆者13例(54.3%);该13例中≥2段可逆者占69.2%。4小时不可逆的70段中29段晚期再灌注良好(54.0%)。与5小时显象比较有非常显著差异,P<0.001。如以轻度以上铊201再分布为标准,则4小时为57段(44.9%),5小时为68段(53.3%),24小时为55段(43.3%),72小时为76段(59.8%)。结果提示,本方法能提高缺血区铊再灌注率,发现冬眠心肌较常规铊静息运动试验更敏感,从而为患者血管重建提供客观依据。

     

    Abstract: Twenty-four patients with prior myocardial infarction were studied who underwent thallium 201 stress-redistribution-reinjection positron emission tomography (PET). All patients underwent thallium imaging 10min. 4h. 5h. 24h. and 72h after stress. In a total of 127 tomographic myoardial segments with definite post-stress thallium 201 perfusion defects, there were 57 segments (44.9%) to be perfused in 4h imaging. 68 segments (53.3%) in 5h, 55 (43.3%) in 24h and 76 (59.8%) in 72h imaging. When the criterion of late reversibility was defined as ≥1 segments with 4h nonreversible defects demonstrating late reversibility, it was presented in 13 (54.3%) of the 24 patients. In these 13 patients, there were only 1 segment late reversible in 4 patients (30.8%), 2 segments in 5 (38.4), ≥3 segmeuts in 4 patients (30.8%). The Frequency of detected reversible defects increased from 29.29/0 in 4h imaging to 54.0% in 72h imaging, P<0.001. Our findings suggest that the reinjection late thallium imaging by PET could improve the rate of thallium reperfusion in the ischemic region and the differentiation of viable from infarcted myocardium. The reinjection late thalliun imaging was more sensitive than 4h delayed image in detecting hibernating myocardium.

     

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