Myocardial scintigraphy with technetium-99m stannous pyrophosphate: an insensitive test for nontransmural myocardial infarction.
Myocardial scintigraphy with technetium-99m stannous pyrophosphate: an insensitive test for nontransmural myocardial infarction.
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锝-99m 焦磷酸亚锡心肌闪烁扫描：非透壁心肌梗死的不敏感测试。
DOI：
10.1016/s0002-9149(79)80003-x
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发表时间：
1979
期刊：
影响因子：
--
通讯作者：
W. Parmley
中科院分区：
文献类型：
--
作者：
B. Massie;E. Botvinick;J. Werner;K. Chatterjee;W. Parmley
锝-99 m焦磷酸盐心肌造影术已被证明是诊断急性透壁性心肌梗死的敏感技术，也被认为是识别非透壁性或内膜下梗死的可靠技术。为了评估焦磷酸盐心肌造影诊断后一种疾病的准确性，我们对31例确诊为非透壁性心肌梗死、43例透壁性心肌梗死和40例稳定型心绞痛患者进行了研究。放射性核素摄取按0至4+的量表分级，并分类为离散或弥漫。弥漫性摄取似乎是非特异性的，发生在19%的内膜下梗死患者和10%的稳定型心绞痛患者中;这两种比率与接受常规骨扫描的无心脏病患者的14%患病率无显著差异。离散性摄取对急性梗死具有高度特异性，但在非透壁性梗死患者中仅发生32%，而在透壁性梗死患者中发生84%（P< 0.001）。在这两个患者组中，肌酸激酶MB水平较高的患者出现了显示离散摄取的血管造影结果表明，心肌酶谱阴性的心肌梗死患者，其心肌酶谱呈弥散性摄取（P< 0.025），而心肌酶谱阴性的心肌梗死患者，其心肌酶谱呈弥散性摄取（P< 0.025），因此，离散性核素摄取是透壁性或非透壁性心肌梗死急性坏死的特异性指标。而弥散摄取是非特异性的。然而，不连续的摄取仅发生在少数内膜下梗死患者中，因此焦磷酸盐脑显像在这些患者中是不敏感的技术。
Myocardial scintigraphy with technetium-99m pyrophosphate has proved to be a sensitive technique for diagnosing acute transmural myocardial infarction and has also been considered reliable in the recognition of nontransmural or subendocardial infarction. To assess the accuracy of pyrophosphate scintigraphy in diagnosing this latter entity, this procedure was studied in 31 patients with a confirmed nontransmural infarct, 43 with a transmural Infarct and 40 with stable angina pectoris. Radionuclide uptake was graded on a scale of 0 to 4+ and classified as discrete or diffuse. Diffuse uptake appeared to be nonspecific, occurring in 19 percent of patients with a subendocardial infarct and in 10 percent of those with stable angina pectoris; neither rate was significantly different from the 14 percent prevalence rate reported among patients without heart disease undergoing routine bone scan. Discrete uptake was highly specific for acute infarction but occurred in only 32 percent of patients with a nontransmural infarct compared with 84 percent of patients with a transmural infarct (P< 0.001). In both patient groups, scintigrams showing discrete uptake occurred in those with higher levels of creatine kinase MB level (P< 0.025), whereas scintigrams showing diffuse uptake occurred in patients whose enzyme level was similar to that of patients with negative scintigrams.It is concluded that discrete radionuclide uptake is a specific indicator of acute necrosis in patients with either transmural or nontransmural infarction, whereas diffuse uptake is nonspecific. However, discrete uptake occurs in only a minority of patients with subendocardial infarction, and therefore pyrophosphate scintigraphy is an insensitive technique in these patients.