GA-67 IMAGING IN PATIENTS WITH DILATED CARDIOMYOPATHY AND BIOPSY-PROVEN MYOCARDITIS
GA-67 IMAGING IN PATIENTS WITH DILATED CARDIOMYOPATHY AND BIOPSY-PROVEN MYOCARDITIS
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DOI：
10.1161/01.cir.70.1.58
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发表时间：
1984-01-01
期刊：
影响因子：
37.8
通讯作者：
GUNNAR, RM
中科院分区：
文献类型：
--
作者：
OCONNELL, JB;HENKIN, RE;GUNNAR, RM
目前临床上心肌炎的检测标准依赖于心肌内膜活检来进行准确诊断。使用这种技术，扩张型心肌病患者的一个子集在组织学上显示出未被怀疑的心肌炎。尽管肌内膜活检具有特异性，但如果炎症是斑片状或局灶性的，由于取样误差，可能缺乏敏感性。炎症敏感的放射性同位素显像可能是诊断心肌炎的一个有用的辅助手段。本研究旨在评价67 Ga心肌显像作为心肌内膜活检辅助诊断心肌炎的适用性。连续性患者（68例）接受了71项平行研究，其中67 Ga成像和活检作为本研究的比较基础。在8%的活检标本中发现了组织学心肌炎。临床和血流动力学参数不能用来预测心肌炎的存在。6例心肌炎活检标本中有5例（87%）显示密集的67 Ga摄取，而65例阴性活检标本中只有9例（14%）与可疑阳性67 Ga扫描配对（P < 0.001）。1例心肌炎且无心肌67 Ga摄取的患者有致密的纵隔淋巴结摄取，可能掩盖了心脏摄取。67 Ga扫描阳性的心肌炎发生率为36%（5/14），而67 Ga扫描阴性的心肌炎发生率仅为1.8%（1/57）。3例随访显示67 Ga摄取与活检心肌炎密切相关。67 Ga可能是一种有用的筛选试验，用于识别活检时心肌炎产率高的患者，并且连续扫描可能消除确诊心肌炎患者频繁活检的需要。
Current standards for detection of myocarditis in a clinical setting rely on endomyocardial biopsy for accurate diagnosis. With this technique a subset of patients with dilated cardiomyopathy show unsuspected myocarditis histologically. Endomyocardial biopsy, despite its specificity, may lack sensitivity due to sampling error if the inflammation is patchy or focal. Inflammation-sensitive radioisotopic imaging may be a useful adjunct in the diagnosis of myocarditis. This study was designed to evaluate the applicability of 67Ga myocardial imaging as an adjunct to endomyocardial biopsy in the diagnosis of myocarditis. Consecutive patients (68) referred for evaluation of dilated cardiomyopathy underwent 71 parallel studies with 67Ga imaging and biopsies that served as the basis of comparison for this study. Histologic myocarditis was identified in 8% of biopsy specimens. Clinical and hemodynamic parameters could not be used to predict the presence of myocarditis. Five of 6 biopsy samples (87%) with myocarditis showed dense 67Ga uptake, whereas only 9 of 65 negative biopsy samples (14%) were paired with equivocally positive 67Ga scans (P < 0.001). The single patient with myocarditis and no myocardial 67Ga uptake had dense mediastinal lymph node uptake that may have obscured cardiac uptake. The incidence of myocarditis on biopsy with a positive 67Ga scan was 36% (5/14); however, the incidence of myocarditis with a negative 67Ga scan was only 1.8% (1/57). Follow-up scans for 3 patients showed close correlation of 67Ga uptake with myocarditis on biopsy. 67Ga may be a useful screening test for identifying patients with a high yield of myocarditis on biopsy, and serial scans may eliminate the need for frequent biopsies in patients with proven myocarditis.