Simultaneous evaluation of myocardial perfusion, metabolism and function by superimposition of myocardial SPECT and echo-cardiography

同时评价局部心肌灌注、代谢、壁运动和交感神经功能对了解心脏疾病的病理生理非常有用。尽管最近心脏核医学的发展使这些同时评估成为可能，但使用心池显像或心肌门控SPECT与Tc-99m标记的心肌灌注剂评估心功能尚未得到完全授权。相比之下，超声心动图对心肌壁运动的评价是非常精确的，但需要在心肌SPECT上叠加准确的局部位置。为此，我们开发了具有里程碑意义的方法，即在回声束的插入部分设置Tc-99m点源标记，并使用双同位素获取方法进行T1-201心肌SPECT成像。使用T1-201进行心肌成像，Tc-99m进行位置标记，这种双同位素方法比单同位素方法更有用，因为相互干扰没有发生。此外，径向长轴SPECT被使用，因为他们是有用的检测断层图，包括Tc-99m源的位置标记。在该方法的临床经验中，回声束的插入部分被证实在前间隔壁上，46.0 （SY.+-）。[)距前壁9.9度。正常患者下壁T1-201心肌摄取（灌注图像）低，前间隔壁运动低。因此，灌注与壁壁运动是相辅相成的，同时评价灌注与壁壁运动有助于提高正常诊断的准确性。在心肌梗死患者中，心肌灌注减少的节段与壁运动减少的节段吻合良好。在肥厚性心肌病患者中，灌注与壁运动之间存在差异，即肥厚节段灌注良好，但壁运动减弱。因此，使用上述方法同时评估心肌灌注（或使用I-123 BMIPP进行代谢或使用I-123 MIBG进行交感神经功能）和壁运动，临床使用简单，有助于评估心肌异常和病理生理。少

Simultaneous evaluation of regional myocardial perfusion, metabolism, wall motion and sympathetic nerve function is very useful for understanding the pathophysiology of cardiac disease. Although recent development of cardiac nuclear medicine enabled these simultaneous evaluation, the evaluation of cardiac function using cardiac pool scintigraphy or myocardial gated SPECT with Tc-99m labeled myocardial perfusion agent is not authorized completely. In contrast, wall motion evaluation using echo-cardiography is very precise, but it is necessary to superimpose the accurate local position on myocardial SPECT.We developed the landmark methods for this purpose, taht is Tc-99m point sorce markers were set on the insert portions of echo-beam and T1-201 myocardial SPECT imaging was performed using dual isotope acquisition method. This dual isotope method using T1-201 for myocardial imaging and Tc-99m for position marking was more useful than single isotope method because mutual interference did … More not occured. Moreover, radial long axis SPECT were used, because they were useful to detect tomograms including position markers of Tc-99m sources. In the clinical experience of this method, the insert portion of echo-beam was proved to be on the antero-septal wall, 46.0 (]SY.+-。[) 9.9 degree from anterior wall. Myocardial uptake of T1-201 (perfusion image) was low in the inferior wall and wall motion was low in the antero-septal wall in normal patients. Terefore, perfusion and wall motion were complementary to each other, and simultaneous evaluation of perfusion and wall motion was useful in the improvement of diagnostic accuracy of normalcy. In patients with myocardial infarction, segments with decreased myocardial perfusion agreed well with those with decreased wall motion. In patients with hypertrophic cardiomyopathy, the discrepancy between perfusion and wall motion was noted, that is, perfusion was good but wall motion was decreased in hypertrophic segments. Thus, the simultaneous evaluation of myocardial perfusion (or metabolism using I-123 BMIPP or sympathetic nerve function using I-123 MIBG) and wall motion using above mentioned methods is simple for clinical use and useful for evaluaion of myocardial abnormalities and pathophysiology. Less