Rest talyum-201 / stres teknesyum-99m sestamibi dual-izotop miyokard perfüzyon SPECT ile sol ventrikül fonksiyonlarının ve viyabilitenin değerlendirilmesi
Küçük Resim Yok
Tarih
2009
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Koroner arter hastalarında, özellikle de revaskülarizasyon planlanlanan vakalarda ileri derecede iskemik ancak canlı miyokard alanları ile infarkte dokuların ayırımını yapmak çok önemlidir. Miyokardiyal viyabiliteyi değerlendirmede en çok kullanılan teknik 201Tl uptake ve redistribüsyonu olmakla birlikte, bu radyofarmasötik belirgin fiziksel limitasyonlara sahiptir. 99mTc işaretli ajanlar ile daha yüksek imaj kalitesi elde edilebilir ve perfüzyon imajlama sırasında EKG-Gated SPECT çekimine olanak sağlar. Dual izotop MPS imajlamada 201Tl ile 99mTc işaretli ajanların birlikte kullanılması sayesinde, viyabilite değerlendirme olanağı ve uygun imaj rezolüsyonu elde edilir.Metot: Çalışma grubumuz, koroner arter hastalığı tanısı almış ve kliniğimize Ekim 2008-Ocak 2009 tarihleri arasında miyokardiyal viyabilite tayini için yönlendirilmiş, 52 hastadan (42'si erkek, 10'u kadın, yaş ortalamaları 60±9) oluşmaktadır. Tüm hastalara rest 201Tl / stres 99mTc-MIBI dual izotop protokolü ile miyokard perfüzyon çalışması uygulanmıştır.Bulgular: 52 hastaya ait toplam 468 segment incelenmiştir. 99mTc-MIBI stres görüntülerinde 341 segmentte normal perfüzyon izlenirken, 127 segmentte perfüzyon defekti saptanmıştır. Rest/stres görüntüleri birlikte değerlendirildiğinde defektif segmentlerin 95'inde (%74,8) doluş mevcut olmakla birlikte 32 segmentte (%25,2) fiks defekt dikkat çekmiştir. Fiks defekt saptanan 13 hastaya 201Tl redistribüsyon imajlama yapılmış ve bu geç görüntülerde 16 segmentte redistribüsyon izlenmiştir. Tüm çalışmanın sonunda defektif segmentlerin %87,4'ünde rest ve redistribüsyon imajlarında doluş gerçekleştiği görülmüştür.Sonuç: Viyabilite tayini açısından en uygun ajan olan 201Tl ile Gated imajlamaya uygun 99mTc işaretli ajanların avantajlarını birleştiren dual-izotop Gated SPECT protokolü, miyokardiyal perfüzyon, viyabilite ve sol ventrikül fonksiyonlarının birlikte değerlendirilmesini olanaklı kılmaktadır
Objective: In patients with coronary artery disease (CAD), differantiation between severely ischemic but potentially viable myocardium and irreversibly infarcted tissue is clinically important, especially when revascularization procedures are considered. Although the use of 201Tl uptake and redistribution to assess myocardial viability is the most widely used technique, this tracer shows physical limitations. 99mTc-labelled agents have been proposed to obtain better image quality and make it possible to perform ECG-Gated SPECT during the acqusition of myocardial perfusion. Combining the use of 201Tl with 99mTc-labelled agents in dual isotope MPS imaging permits optimal image resolution and simultaneous assessment of viability. The more rapid completion of this studies is an another advantage.Method: The study group consisted of 52 patients (42 men and 10 women with a mean age of 60±9 years), with known CAD who were referred for assessment of myocardial viability between October 2008 and January 2009. All patients received 201Tl rest/99mTc-MIBI stress dual isotope myocardial perfusion study.Results: Overall, 468 segments were analyzed in 52 patients. In 99mTc-MIBI stress images, 341 segments were normal and 127 segments were classified as defective. In rest/stress testing, in 95 segments (74.8%) defects were reversible and in 32 segments (25.2%) fixed. In addition a 201Tl redistribution study was performed in 13 patients and in 16 segments redistribution was observed in this late images. Totally 87.4% of defective segments showed reversibility.Conclusion: Dual-isotope rest 201Tl / stress 99mTc-MIBI Gated SPECT protocol can give fast and satisfactory information about myocardial perfusion, viability and left ventricular function. Combining the advantages of 201Tl, the optimal radioisotope for assessment of viability, with 99mTc-labelled agents that suited for the Gated acquisition, makes this protocol valuable in assessing patients with CAD.
Objective: In patients with coronary artery disease (CAD), differantiation between severely ischemic but potentially viable myocardium and irreversibly infarcted tissue is clinically important, especially when revascularization procedures are considered. Although the use of 201Tl uptake and redistribution to assess myocardial viability is the most widely used technique, this tracer shows physical limitations. 99mTc-labelled agents have been proposed to obtain better image quality and make it possible to perform ECG-Gated SPECT during the acqusition of myocardial perfusion. Combining the use of 201Tl with 99mTc-labelled agents in dual isotope MPS imaging permits optimal image resolution and simultaneous assessment of viability. The more rapid completion of this studies is an another advantage.Method: The study group consisted of 52 patients (42 men and 10 women with a mean age of 60±9 years), with known CAD who were referred for assessment of myocardial viability between October 2008 and January 2009. All patients received 201Tl rest/99mTc-MIBI stress dual isotope myocardial perfusion study.Results: Overall, 468 segments were analyzed in 52 patients. In 99mTc-MIBI stress images, 341 segments were normal and 127 segments were classified as defective. In rest/stress testing, in 95 segments (74.8%) defects were reversible and in 32 segments (25.2%) fixed. In addition a 201Tl redistribution study was performed in 13 patients and in 16 segments redistribution was observed in this late images. Totally 87.4% of defective segments showed reversibility.Conclusion: Dual-isotope rest 201Tl / stress 99mTc-MIBI Gated SPECT protocol can give fast and satisfactory information about myocardial perfusion, viability and left ventricular function. Combining the advantages of 201Tl, the optimal radioisotope for assessment of viability, with 99mTc-labelled agents that suited for the Gated acquisition, makes this protocol valuable in assessing patients with CAD.
Açıklama
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine, Koroner hastalık, Coronary disease, Miyokardial reperfüzyon, Myocardial reperfusion, Miyokardial revaskülarizasyon, Myocardial revascularization, Pozitron emisyon tomografi, Positron-emission tomography, Teknesyum Tc-99m, Technetium Tc-99m, Ventriküler fonksiyon-sol, Ventricular function-left
