摘要
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（１３．６４％）再注射显像表现为再充填。２０１Ｔｌ静息－再分布显像和２０１Ｔｌ静息－再分布－再注射显像预测ＰＴＣＡ术后心肌灌注改善的阳性预测值分别为７７．７８％和８０．９５％，阴性预测值分别为７７．７８％和９３．３３％。２０１Ｔｌ静息－再分布显像和２０１Ｔｌ静息－再分布－再注射显像预测存活心肌的准确性分别为７７．７８％和８６．１１％。因此２０１Ｔｌ静息－再分布显像后行再注射显像可提高对部分存活心肌的检出。这种显像方案尤其适合于伴严重左室功能障碍和运动试验有禁忌证的患者的存活心肌的评价。
A study was carried out to
evaluate the clinical value of reinjection imaging after restredistribution 201Tl imaging in
detecting viable myocardium in myocardial infarction 24 patients with myocardial infarction
underwent reinjection imaging after restredistribution 201Tl imaging Eight patients were
followed up by echocardiography before and two to four weeks after percutaneous transluminal
coronary angioplasty (PTCA) The results showed that on rest 201Tl imaging, 97 segments had
abnormal uptake, of which 31 segments were identified with reversible perfusion defects by
means of both 4h redistribution imaging and reinjection imaging after restredistribution imaging
Of the 66 segments with irreversible defects identified by redistribution imaging, 9(1364%) had
increased uptake by reinjection imaging In the eight patients studied before and after PTCA, the
positive predictive values for myocardial viability (wall motion improved after PTCA) were
7778% and 8095% and the negative predictive values were computed,single photon7778% and
9333% by restredistribution and restredistributionreinjection 201Tl imaging respectively The
predictive accuracies were 7778% and 8611% by restredistribution and
restredistributionreinjection 201Tl imaging respectively So reinjection imaging after
restredistribution 201Tl imaging improves the detection of a part of viable myocardium, the
technique may be used for identifying viable myocardium, especially in the patients with
severe left ventricular dysfunction and contraindications to stress testing
