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目的探讨运动试验同时行 ~(18)F-脱氧葡萄糖(FDG)心肌代谢和~(99)Tc-~m-甲氧基异丁基异腈(MIBI)心肌灌注显像判断心肌缺血的可行性和诊断价值。方法 26例既往无心肌梗死病史的确诊或怀疑冠心病患者,在运动试验高峰或出现终止指标时注射~(99)Tc~m-MIBI 和~(18)F-FDG,进行心肌灌注和代谢显像,随后进行静息~(99)Tc~m-MIBI 心肌灌注显像以及冠状动脉造影。比较运动~(18)F-FDG 心肌代谢显像和~(99)Tc~m-MIBI 心肌灌注显像及冠状动脉造影结果。结果 22例有1支及其以上冠状动脉狭窄≥50%的患者中,18例出现血流灌注异常,灵敏度为82%,20例患者有明显~(18)F-FDG 摄取,灵敏度为91%,两者比较差异无显著性(X~2=1.497,P=0.338)。静息~(99)Tc~m-MIBI 心肌灌注显像示完全(12例)或部分(3例)可逆性心肌灌注缺损(心肌缺血)的患者同时行运动试验~(99)Tc~m-MIBI 心肌灌注、~(18)F-FDG 心肌代谢显像,表现为血流灌注减低的心肌节段~(18)F-FDG 摄取增加。与冠状动脉造影对比,22例患者共51个病变血管(管腔狭窄≥50%)支配的心肌节段中,运动试验~(99)Tc~m-MIBI 心肌灌注显像发现了25个节段,灵敏度为49%,而运动~(18)F-FDG 心肌代谢显像发现了34个节段,灵敏度为67%(X~2=7.30,P=0.008)。结论运动试验引起心肌缺血可以进行~(18)F-FDG 心肌代谢显像。且与单纯运动/静息心肌灌注显像比较,同时行运动试验~(99)Tc~m-MIBI 心肌灌注和~(18)F-FDG 心肌代谢显像对诊断局部缺血心肌节段有更高的准确性。
OBJECTIVE: To investigate the feasibility of simultaneous myocardial exercise test with ~ (18) F-deoxyglucose (FDG) myocardial metabolism and ~ (99) Tc- ~ m-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging Diagnostic value. Methods Twenty-six patients diagnosed or suspected coronary heart disease with no past history of myocardial infarction were injected with 99 Tc m -MIBI and 18 F-FDG at the peak of exercise test or at the end of the test. Myocardial perfusion and metabolism were performed Like, followed by resting ~ (99) Tc ~ m-MIBI myocardial perfusion imaging and coronary angiography. The myocardial metabolic imaging of ~ (18) F-FDG and myocardial perfusion imaging of ~ (99) Tc ~ m-MIBI and coronary angiography were compared. Results Among the 22 patients with coronary artery stenosis ≥50%, 18 patients had abnormal blood flow perfusion, with a sensitivity of 82%. The 20 patients had ~ (18) F-FDG uptake with a sensitivity of 91% , No significant difference between the two (X ~ 2 = 1.497, P = 0.338). Resting ~ (99) Tc ~ m-MIBI myocardial perfusion imaging in patients with complete (12 cases) or partial (3 cases) of reversible myocardial perfusion defects (myocardial ischemia) -MIBI myocardial perfusion, ~ (18) F-FDG myocardial metabolic imaging showed increased uptake of ~ (18) F-FDG in myocardial segments with reduced perfusion. Compared with coronary angiography, in the myocardial segments dominated by 51 lesions (≥50% of stenosis) in 22 patients, 25 segments were found by myocardial perfusion imaging of 99 Tc m-MIBI in exercise test , With a sensitivity of 49%. 34 segments were found in 18 F-FDG myocardial metabolic imaging with a sensitivity of 67% (X 2 = 7.30, P = 0.008). Conclusion Myocardial ischemia induced by exercise test can be used for 18 F-FDG myocardial metabolism imaging. Compared with pure exercise / rest myocardial perfusion imaging, simultaneous exercise test ~ (99) Tc ~ m-MIBI myocardial perfusion and ~ (18) F-FDG myocardial metabolic imaging were more effective in diagnosing ischemic myocardial segments High accuracy.