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

同时评价局部心肌血流灌注、代谢、室壁运动和交感神经功能对了解心脏疾病的病理生理学有重要意义。虽然心脏核医学的最新发展使这些同步评价成为可能，但使用心池核素显像或心肌门控SPECT结合99m标记的心肌灌注剂来评价心功能并不是完全正确的。对比超声心动图评价室壁运动的准确性，但需要在心肌SPECT上叠加准确的局部位置。为此，我们发展了标志性方法，在回声束插入部设置~(99m)Tc-SORCE标记物，采用双核素采集法进行T1-201心肌SPECT显像。这种用T1-201进行心肌显像，用~(99)Tc作位置标记的双核素方法比单核素方法更有用，因为…是相互干扰的更多的事情没有发生。此外，还使用了放射状长轴SPECT，因为它们有助于检测包括位置标记的Tc-99m源的断层图像。临床经验证明，超声心动图的附着部位于前间隔壁上，为46.0%。-.[)距前壁9.9度。正常患者下壁T1-201心肌显像低摄取，前间隔低室壁运动。因此，血流灌注和室壁运动是相辅相成的，同时评价血流灌注和室壁运动有助于提高正常诊断的准确性。在心肌梗塞患者中，心肌灌注减少的节段与室壁运动减少的节段符合得很好。在肥厚型心肌病患者中，血流灌注与室壁运动之间存在差异，即肥厚节段的血流灌注良好，但室壁运动减弱。因此，用上述方法同时评价心肌血流(或代谢用I-123BMIPP或交感神经功能用I-123MIBG)和室壁运动是一种简便的临床方法，对心肌异常和病理生理的评价是有用的。较少

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