Myocardial perfusion damage after mediastinal irradiation for Hodgkin's disease: a thallium-201 single photon emission tomography study
Myocardial perfusion damage after mediastinal irradiation for Hodgkin's disease: a thallium-201 single photon emission tomography study
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霍奇金病纵隔照射后的心肌灌注损伤：铊 201 单光子发射断层扫描研究
DOI：
10.1007/bf00168163
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
A. Desgrez
中科院分区：
文献类型：
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作者：
C. Maunoury;J. Pierga;H. Valette;G. Tchernia;J. Cosset;A. Desgrez
关于霍奇金病纵隔照射后心肌异常发生率的报道数据相互矛盾。我们研究了31例临床无症状患者（男13例，女18例，平均年龄35岁）在地幔野放疗后7年（范围3-11年）的心肌灌注情况。在运动后、4 h后和休息时（8-15 d后）获得铊-201断层显像数据。将图像与35名冠状动脉疾病可能性较低的受试者的图像进行视觉和定量分析（短轴切片公牛眼图像201T1摄取的扇形量化）。25个层析数据集可用。21例（84%）患者的视觉图像异常，显示异质201Tl摄取。在68%的受试者中，局部201Tl摄取低于低可能性冠状动脉疾病受试者的平均201Tl摄取值减去2个标准差。10例（40%）患者出现显著的再分布（定量评估≥10%）。在大多数患者中，缺损的位置和形状在解剖学上与心外膜冠状血管疾病无关。这些结果表明，纵隔照射后，201Tl心肌摄取经常出现异常。观察到的模式提示小冠状血管疾病和/或心肌纤维化的存在，而不是心外膜冠状动脉疾病。
Conflicting data have been reported on the incidence of myocardial abnormalities after mediastinal irradiation for Hodgkin's disease. We studied myocardial perfusion in 31 clinically asymptomatic patients (13 male, 18 female, mean age 35 years) 7 years (range 3–11 years) after mantle field radiotherapy. Thallium-201 tomoscintigraphic data were obtained after exercise, 4 h later and at rest (8–15 days later). Images were analysed visually and quantitatively (sectorial quantification of 201T1 uptake on the bull's eye images of the short-axis slices) compared with those of 35 subjects with a low likelihood of coronary artery disease. Twenty-five tomographic data sets were available. Images were visually abnormal in 21 patients (84%) showing an heterogeneous 201Tl uptake. In 68%, the sectorial 201Tl uptake was lower than the mean 201Tl uptake value minus 2 standard deviations measured in subjects with a low likelihood of coronary artery disease. Significant redistribution (quantitatively assessed ≥ 10%) was present in 10 patients (40%). In most of the patients, the location and the shape of the defect(s) could not be anatomically related to an epicardial coronary vessel disease. These results indicate that after mediastinal irradiation the 201Tl myocardial uptake is frequently abnormal. The observed patterns suggest a disease of the small coronary vessels and/or the existence of a myocardial fibrosis rather than epicardial coronary artery disease.