CAJ | 학술논문

目的探讨双嘧达莫负荷心肌201Tl SPECT显像在诊断冠状动脉微循环障碍中的价值.方法选取临床符合心脏X综合征诊断标准的患者共48例,按患者体质量0.56mg/kg予双嘧达莫针剂静脉注射(4min),在心脏负荷达高峰后注入201Tl 111 MBq,10min及240min后分别进行心肌201Tl SPECT显像,原始图像经三维重建后由2位以上有经验的核医学科医师进行分析.对出现“反向再分布”现象的患者采用山莨菪碱(654-2)治疗2周后,再次进行双嘧达莫负荷心肌201TlSPECT显像,同时比较患者治疗前后临床症状和平板运动试验结果.结果 48例患者中有42例延迟(240min)显像时均显示部分心肌节段反向放射性分布稀疏或缺损,即“反向再分布”,检出阳性率为87.50％(42/48).在42例出现“反向再分布”现象的患者中,治疗后临床症状及平板运动试验结果均有改善的36例患者再次进行延迟(240min)显像时原受累的49个节段中有45个节段放射性分布有不同程度改善,检出阳性率达91.84％(45/49).两者有1项未改善或2项均未改善的6例患者延迟(240min)显像时原受累的7个节段放射性分布无改善.结论双嘧达莫负荷心肌201Tl SPECT显像对诊断以心脏X综合征为代表的冠状动脉微循环障碍疾病有一定的价值.
목적 탐토쌍밀체막부하심기201Tl SPECT현상재진단관상동맥미순배장애중적개치.방법 선취림상부합심장X종합정진단표준적환자공48례,안환자체질량0.56mg/kg여쌍밀체막침제정맥주사(4min),재심장부하체고봉후주입201Tl 111 MBq,10min급240min후분별진행심기201Tl SPECT현상,원시도상경삼유중건후유2위이상유경험적핵의학과의사진행분석.대출현“반향재분포”현상적환자채용산랑탕감(654-2)치료2주후,재차진행쌍밀체막부하심기201TlSPECT현상,동시비교환자치료전후림상증상화평판운동시험결과.결과 48례환자중유42례연지(240min)현상시균현시부분심기절단반향방사성분포희소혹결손,즉“반향재분포”,검출양성솔위87.50％(42/48).재42례출현“반향재분포”현상적환자중,치료후림상증상급평판운동시험결과균유개선적36례환자재차진행연지(240min)현상시원수루적49개절단중유45개절단방사성분포유불동정도개선,검출양성솔체91.84％(45/49).량자유1항미개선혹2항균미개선적6례환자연지(240min)현상시원수루적7개절단방사성분포무개선.결론 쌍밀체막부하심기201Tl SPECT현상대진단이심장X종합정위대표적관상동맥미순배장애질병유일정적개치.
Objective To evaluate the value of dipyridamole stress 210Tl myocardial SPECT in detecting dysfunction of coronary microcirculation.Methods Forty-eight patients diagnosed with cardiac syndrome X underwent dipyridamole stress 210Tl myocardial SPECT.Dipyridamole (0.56 mg/kg) was intravenously injected over 4 min followed by 201Tl (111 MBq) injection at 2 min after dipyridamole administration.Image was acquired at 10 min and 240 min post-injection and co-analyzed by over two experienced doctors in nuclear medicine after three-dimensional reconstruction.The patients with " reverse redistribution" underwent repeated dipyridamole stress 201Tl SPECT after medical therapy for 2 weeks.The clinical symptoms and results of the treadmill exercise test pre-and post-therapy were compared.Results Fortytwo patients (42/48,87.50％) showed segmental defects:"reverse redistribution" on delayed (240 min)201Tl images.After medical treatment,36 cases of the 42 "reverse redistribution" patients had improvement in both clinical symptoms and treadmill exercise test.Post-treatment 201Tl imaging showed improvement in 45/49 (91.84％) defect segments.Six of the 42 patients had no improvement in clinical symptoms and/or treadmill exercise test.Post-treatment 201Tl imaging showed no improvement in all the 7 defect segments on the first scan.Conclusion Dipyridamole stress 201Tl myocardial SPECT may be valuable in evaluation of impaired coronary microcirculation associated with cardiac syndrome X.