双核素心肌断层显像方法

1. 双核素心肌断层显像方法

2. 仪器 ◆采用 elscint varicam 双探头SPECT (GE公司提供），配备超高能准直器 (UHEC)。 ◆双探头采用90度垂直位(L-mode) 进行分步采集。

3. 体位 ◆患者取仰卧位，双手抱头充分暴 露心前区。 ◆探头尽量贴近患者以最大限度增 加计数，减少噪声。

4. 采集条件 采 集 程 序 为 系统 自 带双核素断层采集 程序 ( HEI/MIBI ECT Dual Isotope) ; 能 峰为140kev 及 511kev、窗宽20%；矩阵 64×64 ；采集时间为 30-35秒；探头旋转 角度为90度(由左前至右后共180度）、每 3度一帧分步采集。

5. 处理条件 采用滤波反投影法进行重建，分别得到 水平长轴、短轴及垂直长轴三个断面的 图象；滤波函数采用butterworth,截止频 率为0.45, 权重值为4.5。

6. 血糖调节 静脉注射99Tcm-MIBI20mCi，45分钟后测定患者的血糖浓度，将血糖浓度控制在7.9-8.8mmol/L之间。如果患者血糖浓度低于7.8mmol/L需要口服葡萄糖补充，如果血糖浓度高于8.9mmol/L则需要皮下注射胰岛素降低血糖浓度。在血糖控制后10-15min，静脉注射18F-FDG 6-8mCi，一小时后显像。

7. Case 1 LJZ History : 67 – year - old male, 2 years history of progressive typical exertional angina and inferior myocardial infarction. Cardiac risk factors included age, known history of CAD. The resting ECG revealed sinus bradycardia and evidence of an old inferior myocardial infarction.

8. Clinical course Cardiac catheterization revealed a 100% LAD lesion and 90% narrowing of the right coronary artery. The patient underwent successful coronary bypass surgery .

9. DISA imaging protocol MIBI Plasma glucose FDG DISA 0′ 40′ 60′ 120′(min) Plasma glucose 140~160mg%. Plasma glucose level  140mg%, 50-75g glucose. Diabetes mellitus, Insulin was subcutaneously injected according to the plasma glucose.

10. Case 2 WCD A 62-year-old female with no past cardiac history presented with a 6 month history of exertional chest pain with both typical and atypical feature. Cardiac risk factors included hypercholesterolemia, family history of CAD. The resting ECG revealed normal.

11. Hospital course Cardiac catheterization : LAD 90% , LCX 80%, RCA 60% Clinical diagnosis: CAD Angina pectoris The patient underwent CABG.

12. Case 3 LJX 44-year-old male without known CAD presented with a 3 year history of atypical chest pain and dyspnea on exertion. Cardiac risk factors included cigarette smoking. No history of hypertension , diabetes mellitus . ECG revealed nonsepecific T wave abnormalities. Echocardiography revealed dilated left ventricle and atrium.Severe left ventricular hypokinesis. LVEF=25%

13. Clinical course Cardiac catheterization : Three coronary vessels. There was a 80% LAD lesion, 90% narrow of the left circumflex artery and 50% lesion in the right coronary artery . One month later the patient underwent CABG.

14. Case 4 GTB A 58-year-old man presented with mild congestive heart failure 1 year. He had often experienced a chest tightness, and shortness of breath. Cardiac risk factors included age and hypercholesterolemia. The resting ECG revealed LBBB. The resting MIBI - FDG SPECT(DISA) was performed.

15. Clinical course Cardiac catheterization: three coronary artery disease , LAD 80% LCX 60% RCA 95% The patient underwent PTCA of mid RCA lesion.

16. Case 5 A man 52 - year - old presented with progressive exertional angina despite maximal medical therapy. He had had two previous myocardial infarction. Cardiac risk factors included known CAD, age, hypertension and family history of CAD. His resting ECG revealed evidence of an old anterior myocardial infarction.

17. Clinical course Cardiac Catheterization:100% LAD lesion , 100% proximal circumflex marginal lesion. Ventriculogram revealed an anteroapical aneurysm. The patient underwent CABG and neurysmectomy.

18. Case 6 CBK A 66-year -old without know CAD presented with recent onset of chest fullness on exertion, which was relieved with rest. Cardiac risk factors included diabetes mellitus and tobacco use . The resting ECG was normal.

19. Clinical course Cardiac catheterization: 90% stenosis of LAD. The patient underwent successful of PTCA and stent of the proximal LAD lesion.

20. Case 7 Hsyi A 67 – year - old male presented with atypical chest pain and shortness of breath . He had experienced an anterior myocardial infarction 8 year prior. He had stopped smoking cigarettes, and his hyperlipidemia and hypertension were well controlled with medication. The resting ECG revealed an old anterior myocardial infarction.

21. Hospital course Cardiac catheterization: LAD 100% , LCX mid 90% stenosis. The patient was treated with medicine.

22. Case 8 Mzl A 46 - year - old male with a history of myocardial infarction 2 years. Cardiac risk factors included cigarette smoking . The resting ECG revealed an old inferior myocardial infarction.

23. Case 9 Slt A 49- year-old male had had an anterior myocadial infarction 1 year previously. Recently he began to hypotension and mild congestive heart failure. Cardiac risk factors: age, positive family of CAD.

24. Hospital course Cardiac catheterization: (1) LAD 100% occulsion; (2) anteroapical aneurysm. Cardiac death, one month later.

25. Case 10 A 58-years-old male with hypertension of 8 years duration had an inferior myocardial infarction 2 years before. Cardiac risk factors included age and hypertension. The resting ECG revealed an old inferior myocardial infarction..

26. Hospital course Coronary angiography showed three vessles stenosis. LAD 70% LCX 60% RCA 95% The patient underwent PTCA of RCA.

27. Cedars-Sinai法门控心肌断层显像

28. 结果 左室局部功能比较 77例患者的539段心肌节段中，门控MIBI显像和LVG的符合率为82.9%；门控FDG显像和LVG的符合率为78.9%。

29. LVG和门控MIBI比较 门控MIBI LVG 0 1 2 3 0 249 19 10 0 1 0 98 18 0 2 0 26 61 9 3 0 0 12 39 两者符合率达82.9%

30. LVAG和门控FDG比较 门控MIBI LVG 0 1 2 3 0 231 23 14 8 1 0 98 18 0 2 0 21 66 9 3 0 0 21 30 两者的符合率为78.9%

31. 造影结果 患者于2000年11月5日行冠状动脉+左心室造影，11月10日行门控双核素显像。造影发现LAD 狭窄30-40% ，RCA（-），LCX（-）；LVEF=38%，前侧壁、心尖部室壁瘤形成。

32. 造影结果 2001年2月2日行冠状动脉+左心室造影：RCA全程斑块；LAD起始至中段扩张狭窄交替，最窄70-80%；LCX全程斑块。LVEF=32%，前侧壁、间隔、膈面运动减弱，心尖运动消失。2001年2月6日行门控双核素显像。

33. 结论 应用99mTc -MIBI/18F-FDG 双核素门控心肌显像，可以在了解左心室心肌的血流灌注和代谢情况的同时，提供左心室功能的重要信息，所得到的LVEF和局部功能有较高的准确性。