| 王建华,近藤武,韩若凌,王岳恒.心肌代谢和灌注不匹配的定量评价 及心功能恢复的预测[J].中国医学影像技术,2003,19(2):167~169 |
| 心肌代谢和灌注不匹配的定量评价 及心功能恢复的预测 |
| Quantitative Evaluation of Myocardial Metabolism/Flow Mismatch and Prediction of Functional Recovery of Left Ventricle |
| 投稿时间：2002-07-12 |
| DOI： |
| 中文关键词: 急性心肌梗死 再灌注 心肌代谢/血流不匹配 左室功能 核素心肌断层显像 |
| 英文关键词: |
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| 中文摘要: |
| 目的 定量评价急性心肌梗死(AMI)再灌注后心肌代谢和血流灌注不匹配区域与发病1个月后左室功能恢复之间的关系。 方法 接受再灌注治疗的AMI患者18例,1周内实施201TlCl和123I-β-甲基碘苯十五烷酸(123I-BMIPP)双核素心肌断层显像并制成BMIPP/Tl图像,分析BMIPP/Tl异常区域与1个月后左室功能恢复之间的关系。 结果 BMIPP/Tl在0.94~0.85区域的像数与1个月后左室射血分数和室壁运动计分的改善(ΔLVEF和ΔWMS)之间呈显著正相关,但BMIPP/Tl<0.85区域的像数和ΔLVEF和ΔWMS不相关。 结论 应用BMIPP/Tl图像定量评价AMI再灌注后心肌代谢和灌注的不匹配程度,可以客观地评价疗效和预测慢性期心功能的恢复,有十分重要的临床意义。 |
| 英文摘要: |
| Objective To determine the relation between myocardial metabolism/flow mismatch and functional recovery of left ventricle one month after reperfusion in patients with acute myocardial infarction (AMI). Methods 123I-BMIPP and 201TlCl dual SPECT of myocardial scintigraphy were performed within one week in 18 patients with reperfused AMI. With self-developed software,a calculated image of BMIPP/Tl was made and the pixels with abnormal ratios of BMIPP/Tl were correlated with the extent of functional recovery of left ventricle. Results The pixels with a BMIPP/Tl ratio between 0.94-0.85 showed a significant correlation with the improvement of segmental wall motion and the functional recovery of left ventricle,while no significant relation was found between the pixels of BMIPP/Tl ratio<0.85 and LV function. Conclusion Quantitative BMIPP/Tl analysis may have significant clinical implications for its objective evaluation of therapeutic effects and accurate prediction of functional recovery of left ventricle after reperfused AMI. Acute myocardial infarction; Reperfusion; Myocardial metabolism/flow mismatch; Function of left ventricle; Myocardial scintigraphy 急性心肌梗死(AMI)患者再灌注后梗死区存在脂肪酸代谢和血流灌注的不匹配(metabolism/flow mismatch)现象,可能提示顿抑心肌的存在,在一定程度上能够预测左室功能的恢复。但以往的研究大多局限于定性或半定量评价。本研究在AMI患者再灌注后实施201TlCl和123I-β-甲基碘苯十五烷酸(123I-BMIPP)双核素心肌断层显像并制成BMIPP/Tl图像,旨在定量评价BMIPP/Tl异常区域与AMI后1个月左室功能恢复之间的关系。 1 材料和方法 1.1 研究对象 初发AMI患者18例,男14例,女4例,平均年龄(62.9±9.0)岁。所有病例均在发病后12h内成功实施再灌注治疗,并经冠脉造影证实再通血管血流达TIMI 3级。 1.2 显像方法 发病一周内实施123I-BMIPP和201TlCl双核素心肌断层扫描。首先静脉注射123I-BMIPP 111MBq,30min后采集图像。随后注射201TlCl 74MBq,10min后采集图像。图像采集时分别设定123I-BMIPP和201TlCl的能量窗并进行crosstalk的校正。使用日立RC-2600 Gammacamera SPECT仪和RW-3000计算机进行图像采集和处理,配低能高分辨准直器。 1.3 BMIPP/Tl图像及定量分析 从123I-BMIPP和201TlCl左室短轴SPECT图像制成靶心图,并除以各自总计数以求标准化。应用本室开发的软件将标准化的123I-BMIPP和图1 BMIPP/Tl图像及定量分析。本图为一38岁男性,急性前壁心肌梗死患者,左一:BMIPP图像;左二:Tl图像;左三:BMIPP/Tl图像;左四:BMIPP/Tl＜0.95的区域显示,像数为719 图2 BMIPP/TlCL在0.94~0.85区域的像数与△WMS和△LVEF之间的关系 图3 BMIPP/Tl在＜0.85区域的像数与△WMS和△LVEF之间的关系 |
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