研究会 第10回 心臓核医学研究会 虚血性心疾患に対するExercise/Reinjection心筋SPECTの有用性 安静時心筋SPECTとの対比検討
負荷心筋シンチ(ES)のみではviableな心筋を過小評価するとされ,ES24時間後像,安静時心筋シンチ(RS)の追加の有用性が報告されている、我々はES終了後,37MBqの201-T1をreinjectionし得られた画像(REINJ)を別の日に施行したRSと対比検討した.対象は急性心筋梗塞症(AMI)19例,梗塞後狭心症を有する陳旧性心筋梗塞症(OMI)6例,狭心症(AP)6例である.画像解析は視覚的評価法(VI)と極座標表示(BE)からの定量評価を行った.ES初期像(EI),遅延像(ED),REINJ, RS初期像(RI),遅延像(RD)の各々について,VIは短軸,垂直断層像から20 s...
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| Published in | 心臓 Vol. 22; no. 1; pp. 85 - 93 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
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公益財団法人 日本心臓財団
15.01.1990
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| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.22.1_85 |
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| Abstract | 負荷心筋シンチ(ES)のみではviableな心筋を過小評価するとされ,ES24時間後像,安静時心筋シンチ(RS)の追加の有用性が報告されている、我々はES終了後,37MBqの201-T1をreinjectionし得られた画像(REINJ)を別の日に施行したRSと対比検討した.対象は急性心筋梗塞症(AMI)19例,梗塞後狭心症を有する陳旧性心筋梗塞症(OMI)6例,狭心症(AP)6例である.画像解析は視覚的評価法(VI)と極座標表示(BE)からの定量評価を行った.ES初期像(EI),遅延像(ED),REINJ, RS初期像(RI),遅延像(RD)の各々について,VIは短軸,垂直断層像から20 segmentに心筋を分割しscore化した。BEでは,正常者より求めたmean±2SDよりextentscOre(ES),sevirityscore(SS)を算出し,虚血の改善度の指標としてED,REINJ,RI,RDのscoreをEIで除して%ES,%SSとした.VIではAMIのsegmentはOMI,APのそれに比して明らかにREINJ,RSの有用例が多かった.BEではAMIの%ES,%SSは各々EI,ED,REINJ,RI,RDで%ES79.5±24.9,66.4±21.7,50。7±29,0,54.3±26.1,%SSでは57.0±24.9,34.5±20.1,21.2±16.9,26.8±19。3とREINJ,RI,RDでEDに比して有意に改善した.OMI,APでは有意差はなく,EDでの%SSはAPで14.4±133,0MIで26.6±15.1と小さくREINJ,RSの有用例は少なかった.AMIの場合,ESのみではviableな心筋を過小評価しており,REINJはRSに代わる簡便かつ有用な手段である. |
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| AbstractList | 負荷心筋シンチ(ES)のみではviableな心筋を過小評価するとされ,ES24時間後像,安静時心筋シンチ(RS)の追加の有用性が報告されている、我々はES終了後,37MBqの201-T1をreinjectionし得られた画像(REINJ)を別の日に施行したRSと対比検討した.対象は急性心筋梗塞症(AMI)19例,梗塞後狭心症を有する陳旧性心筋梗塞症(OMI)6例,狭心症(AP)6例である.画像解析は視覚的評価法(VI)と極座標表示(BE)からの定量評価を行った.ES初期像(EI),遅延像(ED),REINJ, RS初期像(RI),遅延像(RD)の各々について,VIは短軸,垂直断層像から20 segmentに心筋を分割しscore化した。BEでは,正常者より求めたmean±2SDよりextentscOre(ES),sevirityscore(SS)を算出し,虚血の改善度の指標としてED,REINJ,RI,RDのscoreをEIで除して%ES,%SSとした.VIではAMIのsegmentはOMI,APのそれに比して明らかにREINJ,RSの有用例が多かった.BEではAMIの%ES,%SSは各々EI,ED,REINJ,RI,RDで%ES79.5±24.9,66.4±21.7,50。7±29,0,54.3±26.1,%SSでは57.0±24.9,34.5±20.1,21.2±16.9,26.8±19。3とREINJ,RI,RDでEDに比して有意に改善した.OMI,APでは有意差はなく,EDでの%SSはAPで14.4±133,0MIで26.6±15.1と小さくREINJ,RSの有用例は少なかった.AMIの場合,ESのみではviableな心筋を過小評価しており,REINJはRSに代わる簡便かつ有用な手段である. |
| Author | 板金, 広 飯田, 英隆 安田, 光隆 奥, 久雄 秋岡, 要 竹内, 一秀 戸田, 為久 越智, 宏暢 武田, 忠直 田原, 旭 寺柿, 政和 |
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| References | 15) Brunken, R., Schwaiger, M., Grover-Mckay, M. et al.: Positron emission tomography detec t s tissue metabolic activity in myocardial segments with persistent thallium perfusi o n defects. J. Am. Coll. Cardiol., 10: 557, 1987. 18) Nichols, A. B., Weiss, M. B., Sciacca, R. R. et al.: Relationship between segmental thallium-201uptake and regional myocardial blood flow in patients with coronary artery disease. Circulation, 68: 310, 1983. 11) Beller, G. A., Watson, D. D., Ackell, P. et al.: Time course of thallium 201 redistribution after transient myocardial ischemia. Circulation, 61: 791, 1980. 13) Bodenheimer, M. M., Banka, V. S., Fooshee, C. et al.: Relationship between regional perfusio n and the presence, severity and reversi bility of asynergy in patients with coronary artery di s ease. Circullation, 58: 789, 1978. 14) Tamaki, N., Yonekura, Y., Senda, M. et al.: Value and limitation of stress thallium-201single photon emision computed tomography: Comparison with nitrogen-13 ammonia positron tomography. J. Nucl. Med., 29: 1181, 1988. 5)斉藤宗靖, 住吉徹哉, 石川賢二, ほか: 梗塞後狭心症における梗塞部虚血の役割. 心臓, 16: 1115, 1984. 6) Liu, P., Kiess, M. C., Okada, R. D. et al.: The persistent defect on exercise thallium imagi ng and its fate after myocardial revascularization: dose it represent scar or ischemia ? Am. Heart J., 110: 996, 1985. 9) Rocco, T., Dilsizian, V., McKusick, K. et al.: Redistribution after thallium reinjection: Relationship to coronary anatomy and regional wall motion. J. Nucl. Med., 30: 740, 1989. 12) Pohost, G. M., Zir, L. M., Moore, R. H. et al.: Differentiation of transiently ischemic from infarcted myocardium by serial imaging aftera single dose of thallium-201. Circulation, 55: 294, 1976. 10) Prigent, F., Maddahi, J., Garcia, E. et al.: Noninvasive quantification of the extent of jeop a rdized myocardium in patients with single-vessel disease by stress thallium-201 single photon emission computerized rotational tomography. Am. Heart J., 111: 578, 1986. 19) Weiss, A. T., Maddahi, J., Lew, A. S. et al.: Reverse redistribution of thallium-201: A sign of nontransmural myocardial infarction with patency of the infarct-related coronary artery. J. Am. Coll. Cardiol., 7: 61, 1986. 16) Kiat, H., Berman, D. S., Maddahi, J. et al.: Late reversibility of tomographic myocardial t h allium-201 defects: An accurate marker of myocardial viability. J. Am. Coll. Cardiol., 12: 1456, 1988. 7) Gibson, R. S., Watson, D. D., Taylor, G. J. et al.: Prospective assessment of regional myocardial perfusion before and after coronary r e vascularization surgery by quantitative thallium-201scintigraphy. J. Am. Coll. Cardiol., 1: 804, 1983. 8) Galli, M., Bencivelli, W., Pardo, N. F. et al.: Underestimation of residual ischemia by 201thallium scintigraphy after myocardial inf a rction. Chest, 94: 876. 1988. 20)安野雅夫, 斉藤能彦, 石田保晴, ほか: 急性心筋梗塞における冠動脈再開通療法後の安静および再分布時のthallium-201心筋シンチグラムについて. 心臓, 17: 919, 1985. 17) Strauss, H. W., Harrison, K., Langan, J. K. et al.: Thallium-201 for myocardial imaging: Relation of thallium-201 to regional myocardial perfusion. Circulation, 51: 641, 1975. 1) Pohost, G. M., Zir, L. M., Moore, R. H. et al.: Differentiation of transiently ischemic from infarcted myocardium by serial imaging a fter single dose of thallium-201. Circulation, 55: 294, 1977. 2) Verani, M. S., Jhingran, S., Attar, M. et al.: Post-stress redistribution of thallium-201 in patients with coronary artery disease, with and without prior myocardial infarction. Am. J. Cardiol., 43: 1114, 1979. 4) Pringent, F., Maddahi, J., Garcia, E. et al.: Noninvasive quantification of the extent of jeopardized myocardium in patients with single-vessel coronary disease by stress thallium -201 single-photon emission computerized tomography. Am. Heart J., 111: 578, 1986. 3) Blood, D. K., McCarthy, D. M., Sciacca, R. R. et al.: Comparison of single-dose and doubledose thallium-201 myocardial perfusion scintigraphy for the detection of coronary a rtery disease and prior myocardial infarction. C irculation, 58: 777, 1981. |
| References_xml | – reference: 10) Prigent, F., Maddahi, J., Garcia, E. et al.: Noninvasive quantification of the extent of jeop a rdized myocardium in patients with single-vessel disease by stress thallium-201 single photon emission computerized rotational tomography. Am. Heart J., 111: 578, 1986. – reference: 2) Verani, M. S., Jhingran, S., Attar, M. et al.: Post-stress redistribution of thallium-201 in patients with coronary artery disease, with and without prior myocardial infarction. Am. J. Cardiol., 43: 1114, 1979. – reference: 14) Tamaki, N., Yonekura, Y., Senda, M. et al.: Value and limitation of stress thallium-201single photon emision computed tomography: Comparison with nitrogen-13 ammonia positron tomography. J. Nucl. Med., 29: 1181, 1988. – reference: 3) Blood, D. K., McCarthy, D. M., Sciacca, R. R. et al.: Comparison of single-dose and doubledose thallium-201 myocardial perfusion scintigraphy for the detection of coronary a rtery disease and prior myocardial infarction. C irculation, 58: 777, 1981. – reference: 20)安野雅夫, 斉藤能彦, 石田保晴, ほか: 急性心筋梗塞における冠動脈再開通療法後の安静および再分布時のthallium-201心筋シンチグラムについて. 心臓, 17: 919, 1985. – reference: 9) Rocco, T., Dilsizian, V., McKusick, K. et al.: Redistribution after thallium reinjection: Relationship to coronary anatomy and regional wall motion. J. Nucl. Med., 30: 740, 1989. – reference: 5)斉藤宗靖, 住吉徹哉, 石川賢二, ほか: 梗塞後狭心症における梗塞部虚血の役割. 心臓, 16: 1115, 1984. – reference: 1) Pohost, G. M., Zir, L. M., Moore, R. H. et al.: Differentiation of transiently ischemic from infarcted myocardium by serial imaging a fter single dose of thallium-201. Circulation, 55: 294, 1977. – reference: 6) Liu, P., Kiess, M. C., Okada, R. D. et al.: The persistent defect on exercise thallium imagi ng and its fate after myocardial revascularization: dose it represent scar or ischemia ? Am. Heart J., 110: 996, 1985. – reference: 4) Pringent, F., Maddahi, J., Garcia, E. et al.: Noninvasive quantification of the extent of jeopardized myocardium in patients with single-vessel coronary disease by stress thallium -201 single-photon emission computerized tomography. Am. Heart J., 111: 578, 1986. – reference: 7) Gibson, R. S., Watson, D. D., Taylor, G. J. et al.: Prospective assessment of regional myocardial perfusion before and after coronary r e vascularization surgery by quantitative thallium-201scintigraphy. J. Am. Coll. Cardiol., 1: 804, 1983. – reference: 15) Brunken, R., Schwaiger, M., Grover-Mckay, M. et al.: Positron emission tomography detec t s tissue metabolic activity in myocardial segments with persistent thallium perfusi o n defects. J. Am. Coll. Cardiol., 10: 557, 1987. – reference: 18) Nichols, A. B., Weiss, M. B., Sciacca, R. R. et al.: Relationship between segmental thallium-201uptake and regional myocardial blood flow in patients with coronary artery disease. Circulation, 68: 310, 1983. – reference: 19) Weiss, A. T., Maddahi, J., Lew, A. S. et al.: Reverse redistribution of thallium-201: A sign of nontransmural myocardial infarction with patency of the infarct-related coronary artery. J. Am. Coll. Cardiol., 7: 61, 1986. – reference: 12) Pohost, G. M., Zir, L. M., Moore, R. H. et al.: Differentiation of transiently ischemic from infarcted myocardium by serial imaging aftera single dose of thallium-201. Circulation, 55: 294, 1976. – reference: 13) Bodenheimer, M. M., Banka, V. S., Fooshee, C. et al.: Relationship between regional perfusio n and the presence, severity and reversi bility of asynergy in patients with coronary artery di s ease. Circullation, 58: 789, 1978. – reference: 11) Beller, G. A., Watson, D. D., Ackell, P. et al.: Time course of thallium 201 redistribution after transient myocardial ischemia. Circulation, 61: 791, 1980. – reference: 8) Galli, M., Bencivelli, W., Pardo, N. F. et al.: Underestimation of residual ischemia by 201thallium scintigraphy after myocardial inf a rction. Chest, 94: 876. 1988. – reference: 16) Kiat, H., Berman, D. S., Maddahi, J. et al.: Late reversibility of tomographic myocardial t h allium-201 defects: An accurate marker of myocardial viability. J. Am. Coll. Cardiol., 12: 1456, 1988. – reference: 17) Strauss, H. W., Harrison, K., Langan, J. K. et al.: Thallium-201 for myocardial imaging: Relation of thallium-201 to regional myocardial perfusion. Circulation, 51: 641, 1975. |
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| Subtitle | 安静時心筋SPECTとの対比検討 |
| Title | 研究会 第10回 心臓核医学研究会 虚血性心疾患に対するExercise/Reinjection心筋SPECTの有用性 |
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