Reverse Redistribution in Thallium-201 Myocardial Scintigraphy: Diagnostic Accuracy Improved by Simultaneous Gated SPECT Wall Motion Study

鉈－201心肌灌注造影之逆再分佈現象：以同步閘門單光子心室壁運動造影提升診斷之準確性

王昱豐(Yuh-Feng Wang) ； 林庭光(Tin-Kwang Lin) ； 陳志暐(Chih-Wei Chen) ； 邱建勳(Jainn-Shiun Chiu) ； 林俊龍(Chin-Lon Lin)

《慈濟醫學雜誌》 18卷2期 (2006/04) Pp. 101-108

https://doi.org/10.6440/TZUCMJ.200604.0101

摘要

目的：逆再分佈現象(reverse redistribution phenomenon; RR phenomenon)是臨床上進行鉈－201(T1-201)心肌灌注檢查時偶會遭遇的情形，由於其造成的原因複雜，其結果可能為陽性或陰性，經常造成臨床上難以判斷的難題。本研究利用此心肌灌注造影之結果配合電腦重新組合之同步閘門單光子心室壁運動造影來重組心室壁肌肉運動情形，並與其後患者接受之心導管檢查結果相配合，作為提高其診斷準確度之方法。材料與方法：本研究為病歷回溯性之分析，收集近五年來在本科進行心肌灌注檢查之患者資料，並與其之後一個月內所接受之心導管檢查結果相比對。結果：在符合條件的病患中(n=36)，發現此結合心室壁肌肉運動的分析可以有效提高臨床診斷的正確性，其中診斷正確性為72.2%(26/36)，陽性預測值：71.4%(15/21)，陰性預測值：73.3%(11/15)。結論：對於心肌灌注檢查出現逆再分佈現象的患者中，如果同時出現局部心肌運動異常時，代表臨床上出現冠狀動脈異常之機率相對升高；另外，如果此類患者之心肌活動正常，則可列入冠狀動脈異常之低危險群。

關鍵字

逆再分佈現象 ； 鉈－201心肌灌注檢查 ； 同步閘門單光子心室壁運動造影 ； 心導管

並列摘要

Objective: The reverse redistribution (RR) phenomenon is not infrequently observed during performance of stress/rest Tl-201 myocardial perfusion studies. In patients with a positive medical history (e.g., of myocardial infarction), the prognostic value of RR defect can be high. However, most patients with RR defects do not have high risk profiles, and determining whether these patients should have a coronary angiogram often poses a clinical dilemma. The purpose of this study was to determine whether regional wall motion abnormality improves the prognostic value of RR in Tl-201 myocardial perfusion evaluation. Materials and Methods: In this study, data from patients with RR defects on a myocardial perfusion study who subsequently underwent coronary angiography within one month (n=36) were analyzed and compared. Results: We found that regional wall motion abnormality on ECG-gated SPECT imaging coexisting in the same segment with an RR defect improved the ability of myocardial infusion to detect coronary stenosis. By comparing this combination of myocardial infusion findings with coronary angiographic findings (the gold standard results), we found that the total accuracy rate, positive predictive value, and negative predictive value of the myocardial perfusion study were 72.2% (26/36), 71.4% (15/21), and 73.3% (11/15), respectively. Conclusions: Regional wall motion abnormalities in conjunction with RR indicate a high probability of significant coronary stenosis and patients with these abnormalities should undergo coronary angiography. However, RR without wall motion abnormalities generally indicates a low probability of significant coronary artery stenosis.

並列關鍵字

reverse redistribution ； thallium-201 myocardial perfusion studies ； ECG-gated SPECT ； coronary angiography