【摘要】 目的 探讨多巴酚丁胺负荷—再分布201Tl /静息99Tcm-MIBI双核素心肌断层显像法鉴别活性心肌的临床应用。方法 102例临床怀疑有冠心病的病人进行了多巴酚丁胺负荷—再分布201Tl/静息99Tcm-MIBI同时心肌断层显像，原始图像经三维重建后由两位以上有经验的核医学医师进行图像分析。断层显像后2周内102例病人全部进行了冠状动脉造影。结果 (1)102例病人行冠状动脉造影均发现冠状动脉狭窄，其中单支病变48例，两支病变33例，三支病变21例。(2)20例负荷201Tl图像和静息99Tcm-MIBI图像放射性缺损，再注射201Tl图像发现放射性填充，提示冬眠心肌存在；41例负荷201Tl图像放射性稀疏缺损，静息99Tcm-MIBI图像和再分布201Tl图像发现放射性填充，考虑为缺血心肌；以上两种心肌均为活性心肌。(3)35例负荷201Tl和静息99Tcm-MIBI图像均发现放射性缺损，而再注射201Tl图像未发现放射性填充考虑为梗死心肌即无活力心肌。(4)6例负荷201Tl及再分布201Tl图像和静息99Tcm-MIBI图像均未发现放射性稀疏，为假阴性。结论 多巴酚丁胺负荷—再分布201Tl /静息99Tcm-MIBI双核素心肌断层显像法是一种有效、无创的鉴别活性心肌的方法。

    【关键词】 活性心肌；201Tl；99Tcm-MIBI；双核素; SPECT

    The evaluation of simultaneous 99Tcm-MIBI and 201Tl dual-isotopic myocardial perfusion SPECT imaging in the detection of myocardial viability

    XIE Wen-hui,ZHANG Li-hua,HU Shi-long,et al.

    Department of Nuclear Medicine,Shanghai Chest Hospital,Shanghai 200030,China

    【Abstract】 Objective The clinical role and method of simultaneous rest 99Tcm-MIBI and stress 201Tl dual-isotopic myocardial perfusion SPECT imaging in the detection of myocardial viability.Methods 102 patients with suspected coronary artery disease underwent simultaneous dual-isotopic myocardial perfusion SPECT imaging with 99Tcm-MIBI and 201Tl. At rest 99Tcm-MIBI was injected,15min later dobutamine was instilled into vein begin with 5μg/(kg·min), before and after instilling the ECG,blood pressure,heart rate were recorded. When the end point were achieved, thallium-201 was injected, and the dual-isotopic simultaneously SPECT imagine was performed. The stress and rest imagine was obtained. After tomographic reconstruction, the images were interpreted by two experienced observers without prior knowledge of results of other studies. In two weeks, coronary angiography was performed.Results (1)All of 102 patients were found coronary artery abnormality, 48 with one coronary artery abnormality, 33 with two coronary artery abnormality, 21 with three coronary artery abnormality.(2)of 102 patients, 20 with the defect found on the stress 201Tl and rest 99Tcm-MIBI image show radiofilling on the reinjection images, indicated “hibernating myocardium”; 41 with the defect found on the stress 201Tl image but redistributed on rest 99Tcm-MIBI and the redistribution image, indicated “ischemic myocardium”. Both of them were viable myocardium.(3)35 with the defect found on the stress 201Tl image rest 99Tcm-MIBI and reinjection image, indicated “infarcted myocardium”.(4)6 patients without defect found were false negative.Conclusion Simultaneous 99Tcm-MIBI and 201Tl dual-isotopic myocardial perfusion SPECT imaging is an effective method in the detection of myocardial viability. ......