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中国误诊学杂志 2010年第26期10卷 6444-6444页

作者：李传琼崔邦平代文莉梅云凤胡伟三峡大学第一临床医学院 443003 湖北省宜昌市中心人民医院 443003

目的提高专业知识及护理水平,协助医生、帮助患者顺利完成99mTc-MIBI运动负荷心肌灌注显像检查,提高诊断效能。方法对84例受检者检查前进行卫生宣教和心理护理,检查中进行负荷运动护理指导、病情观察,检查后及时解除的心理顾虑。结果 8... 详细信息

目的提高专业知识及护理水平,协助医生、帮助患者顺利完成99mTc-MIBI运动负荷心肌灌注显像检查,提高诊断效能。方法对84例受检者检查前进行卫生宣教和心理护理,检查中进行负荷运动护理指导、病情观察,检查后及时解除的心理顾虑。结果 84例患者全部顺利完成检查,无任何严重不良反应。结论 99mTc-MIBI心脏运动负荷灌注显像护理人员有效配合能减少并发症,减轻患者心理负担,提高显像质量。

关键词：心肌再灌注/护理心脏/放射性核素显像有机锝化合物/诊断应用人类

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硝酸甘油介入心肌断层显像对存活心肌的判断价值

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中国临床实用医学 2008年第12期2卷 30-31页

作者：尤安民付立武金军薛书峰赵建华洛阳市中心医院核医学科 471009 洛阳市中心医院心内科 471009

目的探讨硝酸甘油介入心肌断层显像对心肌梗死（MI）患者存活心肌的判断价值。方法64例心肌梗死患者经皮冠状动脉介入治疗术（PCI）前行^99mTc-MIBI静息和硝酸甘油（NTG）介入心肌显像，术后3个月时复查静息心肌显像，并进行对比分析。... 详细信息

目的探讨硝酸甘油介入心肌断层显像对心肌梗死（MI）患者存活心肌的判断价值。方法64例心肌梗死患者经皮冠状动脉介入治疗术（PCI）前行^99mTc-MIBI静息和硝酸甘油（NTG）介入心肌显像，术后3个月时复查静息心肌显像，并进行对比分析。结果64例患者静息显像共有232个节段（40．28％）心肌核素摄取异常，NTG介入心肌显像后有132个节段（56．90％）呈可逆性缺损，100个节段（43．10％）呈不可逆性缺损；PCI术后136个心肌节段（58．62％）心肌灌注得到改善，术前NTG介入显像显示的132个可逆性缺损节段，术后120个节段（90．91％）心肌灌注改善，术前NTG介入显像显示的100个不可逆性缺损节段，术后16个节段（16．0％）心肌灌注改善，二者比较差异有统计学意义（P〈0．05）；而26例无存活心肌的一组患者，上述指标在术前和术后差异无统计学意义（P〉0．05）。结论MI患者PCI前常规行NTG介入^99mTc-MIBI心肌显像对是否进行PCI治疗的病例选择有决策性指导作用。

关键词：心脏/放射性核素显像心肌梗死介入治疗硝酸甘油

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磁共振成像对急性心肌梗死后再灌注损伤和左室重构的评估(英文)

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中国临床康复 2005年第27期9卷 208-209页

作者：时惠平高育璈高元桂解放军空军总医院磁共振科北京市100036 解放军总医院放射科北京市100853

背景:磁共振成像对急性心肌梗死的研究多注重心肌灌注改变。目的:分析比较MRI征象中梗死和再灌注心肌的特征,并与病理切片染色结果进行对比。设计:完全随机分组设计,随机对照实验。单位:解放军空军总医院磁共振科,解放军总医院放射科。... 详细信息

背景:磁共振成像对急性心肌梗死的研究多注重心肌灌注改变。目的:分析比较MRI征象中梗死和再灌注心肌的特征,并与病理切片染色结果进行对比。设计:完全随机分组设计,随机对照实验。单位:解放军空军总医院磁共振科,解放军总医院放射科。材料:实验于2003-10/12在解放军总医院动物实验中心完成。选用14只中国小型猪,随机分2组,每组7只,分别为梗死组和再灌注组。分别制成单纯心肌梗死和心肌梗死再灌注动物模型。术前和手术后1个月内多次进行MRI平扫、增强扫描检查。术后1个月取与MRI对应层面及厚度的心脏标本做病理大切片,进行氯化三苯基四氮唑蓝染色检查,对应氯化三苯基四氮唑蓝染色结果分别取梗死心肌(相当于左室前壁)和正常心肌(相当于左室后壁)及其相邻部标本进行苏木精-伊红染色检查观察梗死心肌范围。主要观察指标:两组猪心肌T1和T2弛豫时间改变;梗死和正常心肌的形态改变。结果:纳入中国小型猪14只,梗死组和再灌注组各7只,在造模过程中梗死组死亡1只,进入结果分析猪13只,梗死组6只,再灌注组7只。①T1,T2弛豫时间数值:梗死组梗死区心肌明显大于正常心肌犤(1159.54±78.67),(60.15±6.31)ms,(1056.15±70.95),(47.46±7.94)ms,t=2.63,5.38,P<0.05,0.01犦;再灌注组梗死区心肌也明显大于正常心肌犤(1171.14±139.98),(56.64±6.16)ms,(1074.64±97.61),(44.57±4.25)ms,t=2.64,6.24,P<0.05,0.01犦。②单纯梗死心肌与再灌注梗死心肌在MRI上均有明显强化,但两者弛豫时间和增强特征无明显差别,单纯梗死比再灌注梗死组左室扩大明显。③MRI所见与病理检查结果相对照表明病理切片氯化三苯基四氮唑蓝染色所示梗死区与MRI所见一致。结论:①MRI对心肌梗死以及左室重构评价有价值,MRI和增强扫描不能鉴别梗死和不可逆性再灌注心肌缺血区心肌组织。②再灌注对急性心肌梗死后左室重构改变有治疗作用。③MRI与病理检查具有良好的相关性。

关键词：心肌梗塞/超声检查心肌再灌注损伤疾病模型,动物心脏/放射性核素显像 ’

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多巴酚丁胺—阿托品负荷^(99m)Tc—MIBI心肌灌注断层显像诊断冠心病的临床价值

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中国心血管病研究 2005年第1期3卷 48-51页

作者：张守彦金军尤安民薛书峰马惠芳田利平河南省洛阳市中心医院心内科 471009 河南省洛阳市中心医院核医学科 471009

目的探讨多巴酚丁胺-阿托品负荷99mTc-MIBI心肌断层显像诊断冠心病(CAD)的临床价值。方法对40例健康体检者、60例CAD患者和21例可疑CAD患者行多巴酚丁胺负荷、多巴酚丁胺-阿托品负荷99mTc-MIBI心肌灌注显像,比较二种方法对CAD患者的诊... 详细信息

目的探讨多巴酚丁胺-阿托品负荷99mTc-MIBI心肌断层显像诊断冠心病(CAD)的临床价值。方法对40例健康体检者、60例CAD患者和21例可疑CAD患者行多巴酚丁胺负荷、多巴酚丁胺-阿托品负荷99mTc-MIBI心肌灌注显像,比较二种方法对CAD患者的诊断价值。结果①多巴酚丁胺-阿托品负荷心肌断层显像(Dobu-Atr-MPI)诊断CAD的敏感性明显高于多巴酚丁胺负荷心肌断层显像(Dobu-MPI)(96.7%与76.7%,P<0.05);特异性均为90%,差异无统计学意义(P>0.05);Dobu-Atr-MPI与Dobu-MPI对CAD的阳性预测值分别为93.5%与92.0%,差异无统计学意义(P>0.05),阴性预测值分别为94.7%与72.0%,差异有统计学意义(P<0.05)。②Dobu-Atr-MPI阳性9例的可疑CAD患者8例发生心脏事件,符合率为90%。③Dobu-Atr-MPI时副作用轻微,患者耐受良好。结论①与Dobu-MPI相比,Dobu-Atr-MPI诊断CAD的特异性与前者相似,而敏感性高,为临床CAD的诊断尤其是早期诊断提供了一条新的有价值的途径。②Dobu-Atr-MPI可对CAD心肌缺血或心肌梗死的部位、范围及严重程度作出有意义的评价,并可观察左室腔的大小和室壁厚薄等情况。③对临床上可疑CAD患者而其他无创性检查不足以明确诊断时,Dobu-Atr-MPI可作为CAD筛选和预后评估的方法,为临床治疗提供依据。

关键词：心脏/放射性核素显像冠状动脉疾病/诊断多巴酚丁胺阿托品

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消化源性胸痛核素心肌显像11例分析

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中国误诊学杂志 2005年第15期5卷 2945-2946页

作者：蔡凯暨南大学附属第五医院广东省清远市人民医院心内科511500

对我院1998～2005年以心绞痛为临床症状的消化系统疾病核素心肌显像11例分析如下.1 临床资料1.1 一般资料本组男6例,女5例,年龄36～74岁,平均57岁.其中女性均已绝经并非处于围绝经期.

关键词：胸痛/放射性核素显像心脏/放射性核素显像

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Slow upsloping ST-segment depression during exercise: Does it really signify a positive stress test?

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AMERICAN HEART JOURNAL 2002年第3期143卷 482-487页

作者： Desai, MY Crugnale, S Mondeau, J Helin, K Mannting, F Harvard Univ Brigham & Womens Hosp Sch Med Div Nucl Cardiol Boston MA 02115 USA

Background Slow upsloping ST-segment depression during stress is thought to represent an ischemic response to exercise treadmill testing (ETT). Aim We used modern single-photon emission computed tomography (SPECT) imaging protocols to determine the incidence of ischemia in patients with slow upsloping ST depression during exercise and whether this response signifies more or less severe coronary artery disease (CAD) and risk in comparison with rapid upsloping ST depression and particularly with horizontal or downsloping ST depression. Methods We enrolled 33 patients (group 1) with rapid upsloping ST depression (>1 mm extending <0.08 seconds beyond J point), 3 2 patients (group 2) with slow upsloping depression (> 1.5 mm extending >0.08 seconds beyond J point), and 35 patients (group 3) with horizontal or downsloping depression (>1 mm at 0.08 seconds beyond J point). Summed stress score (SSS), summed difference score (SDS), stress extent percent (SE%) and reversible extent percent (RE%) of perfusion abnormalities, lung-heart ratio (LHR), and transient ischemic dilatation (TID) were calculated. Results The mean SSS, SIDS, SE%, RE%, and LHR were similar between groups 1 and 2 but significantly higher in group 3. Incidence of ischemia was similar in groups I and 2 (39% and 25%) but significantly higher in group 3 (77%, P <.001). Evidence of TID was seen in none of the patients in groups 1, in 3% of patients in group 2, and in 23% of patients in group 3. Conclusions Slow upsloping ST depression does not signify more severe ischemia, more extensive CAD, or more stress-induced backward left ventricular failure. Thus, it would be reasonable to consider patients with slow upsloping ST depression during exercise as having a very low likelihood of CAD, similar to patients with rapid upsloping ST depression.

关键词：方差分析心电描记术运动试验心脏/放射性核素显像肺/放射性核素显像心肌缺血/病因学心肌缺血/病理生理学心肌缺血/放射性核素显像前瞻性研究体层摄影术发射型计算机单光子心室功能左/生理学女(雌)性人类男(雄)性中年人

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Assessment of cardiac viability by thallium 201 redistribution and dobutamine echocardiography

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AMERICAN HEART JOURNAL 2002年第1期143卷 157-162页

作者： Zamorano, JL Delgado, J Almería, C Sánchez, MAG Sotelo, T Moreño, R Meroño, E Fernández, C Rufilanchas, JJ Sánchez-Harguindey, L Hosp Clin San Carlos Madrid Spain Hosp 12 Octubre E-28041 Madrid Spain

Objective Dobutamine echocardiography and thalium 201 are useful in the assessment of myocardial viability, but both techniques frequently yield conflicting results. The objective of this study was to determine the minimum mass of viable myocardium that each test could detect and compare the agreement of dobutamine echocardiography and thallium 201 to detect viability. Methods Dobutamine echocardiography and thallium 201 were performed in 10 patients scheduled for cardiac transplantation. In each patient, 15 segments were studied. After transplantation these segments were analyzed by the pathologist measuring by a computer system the total area of each segment, the necrotic + fatty mass, and area (%) of viable myocytes per segment. The percentage of viable tissue was estimated ([Total mass - (Necrotic + Fatty tissue)]/Total mass x 100) on each segment, which was compared with the result (viable or not viable) obtained by echocardiography or thallium 201. Results Dobutomine echocardiography defined 90 segments (60%) as viable versus 117 (78%) in thallium (kappa 0.49, 95% CI 0.36-0.63). The minimum percent of viable tissue per segment defined as-viable by thallium was 43% versus 49% by echocardiography. With use of thallium, the highest accuracy of the test to detect viability was when the percent of necrotic tissue of the segment analyzed was 40% (positive and negative likelihood ratio 2.2 and 3.6, respectively). By use of echocardiography, the highest accuracy of the test was observed when the percent of necrotic tissue of the segment analyzed was 3 1 % (positive and negative likelihood ratio 5.5 and 7.7, respectively). Conclusion The discrepant results of dobutamine echocardiography and thallium 201 are due to differences in the minimum mass of live myocytes required by each technique to detect viability.

关键词：强心药/诊断应用细胞存活多巴酚丁胺/诊断应用超声心动描记术心脏/放射性核素显像似然函数心肌收缩心肌/病理学坏死前瞻性研究敏感性与特异性铊放射性同位素/诊断应用体层摄影术发射型计算机单光子人类男(雄)性中年人

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Short-term oral estrogen replacement therapy does not augment endothelium-independent myocardial perfusion in postmenopausal women

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AMERICAN HEART JOURNAL 2001年第4期142卷 641-647页

作者： Peterson, LR Eyster, D Dávila-Román, VG Stephens, ALP Schechtman, KB Herrero, P Gropler, RJ Washington Univ Sch Med Div Cardiovasc Dept Med St Louis MO 63110 USA Washington Univ Sch Med Div Geriatr & Gerontol St Louis MO USA Washington Univ Sch Med Dept Obstet & Gynecol St Louis MO USA Washington Univ Sch Med Dept Radiol St Louis MO 63110 USA Washington Univ Sch Med Div Biostat St Louis MO 63110 USA

Objectives Th. purpose of this study was to determine the effect of usual-dose estrogen replacement therapy (ERT) on myocardial perfusion and myocardial perfusion reserve (MPR) (evoked by an endothelium-independent vasodilator) in healthy postmenopausal women. Postmenopausal women have a decreased myocardial perfusion reserve compared with younger women. Estrogen infusions are known to enhance endothelium-dependent vasodilation of the epicardial coronary arteries in postmenopausal women, but whether ERT also enhances endothelium-independent myocardial perfusion and perfusion reserve is unclear. Methods In 2.4 healthy postmenopausal women who were not taking ERT, myocardial perfusion at rest, perfusion during the infusion of adenosine (a primarily endothelium-independent vasodilator), and MPR were determined by positron-emission tomography (PET) and oxygen 15-labeled water. The women were then randomly assigned in a double-blind fashion to receive either 0.625 mg of oral conjugated estrogens (Premarin) or placebo per day for 4 to 6 weeks, after which they underwent a repeat cardiac PET study. Results There was no statistical difference between those assigned to ERT and those assigned to placebo in the measurement of myocardial perfusion at rest (1.21 +/- 0.31 vs 1.16 +/- 0.18 mL/g/min, respectively) in response to adenosine (2.66 +/- 0.96 vs 3.3 +/- 0.45 mL/g/min) or MPR (2.24 +/- 0.83 vs 2.88 +/- 0.64 mL/g/min) after 4 to 6 weeks of oral ERT. There was also no difference between the groups in any of the myocardial perfusion measurements after correction for the rate-pressure product. Conclusions Short-term oral ERT does not affect myocardial perfusion at rest in response to adenosine or MPR in healthy postmenopausal women. Thus potential beneficial effects of ERT on vasomotor function may be limited to enhancement of endothelium-dependent vasodilative mechanisms affecting conduit vessels.

关键词：腺苷/药理学冠状动脉循环/药物作用冠状动脉循环/生理学冠状血管/药物作用冠状血管/放射性核素显像雌激素替代疗法/方法雌激素类共扼(USP)/药理学心脏/放射性核素显像氧放射性同位素/诊断应用绝经后期体层摄影术发射型计算机/统计学和数值数据血管舒张药/药理学水/诊断应用成年人女(雌)性人类

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Gated single-photon emission computed tomographic myocardial imaging: A new tool in clinical cardiology

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AMERICAN HEART JOURNAL 2001年第3期141卷 383-390页

作者： Bavelaar-Croon, CDL Pauwels, EKJ van der Wall, EE Leiden Univ Med Ctr Dept Cardiol NL-2333 AZ Leiden Netherlands Leiden Univ Med Ctr Dept Radiol Div Nucl Med NL-2333 AZ Leiden Netherlands

Background Gated single-photon emission computed tomography (gated SPECT) myocardial perfusion imaging allows the analysis of left ventricular (LV) perfusion and function during the same acquisition. Results Gated SPECT provides additional information to myocardial perfusion, which improves lest specificity in patients with known or suspected coronary artery disease and hence diminishes the amount of borderline diagnosis. Because gated SPECT provides reliable information on LV election fraction and LV volumes, it is also a valuable tool in risk stratification. In addition, from gated SPECT, images can be reconstructed from which wall motion can be assessed showing a good correlation with wall motion assessed by accepted imaging modalities as echocardiography, magnetic resonance imaging, and contrast ongiography. In the future wall motion analysis from gated SPECT may also be used for revascularization stratification. Conclusions Gated SPECT gives important additional information beyond myocardial perfusion imaging alone, which could have major clinical implications for optimal patient management.

关键词：伪迹束支传导阻滞冠心病/病理生理学冠心病/放射性核素显像心脏/放射性核素显像预后放射性药物/诊断应用 99m锝甲氧基异丁基异腈/诊断应用体层摄影术发射型计算机单光子/方法心室功能左人类

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Fast maximum entropy approximation in SPECT using the RBI-MAP algorithm

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IEEE TRANSACTIONS ON MEDICAL IMAGING 2000年第4期19卷 286-294页

作者： Lalush, DS Frey, EC Tsui, BMW Univ N Carolina Dept Biomed Engn Chapel Hill NC 27599 USA Univ N Carolina Dept Radiol Chapel Hill NC 27599 USA

In this work, we present a method for approximating constrained maximum entropy (ME) reconstructions of SPECT data with modifications to a block-iterative maximum a posteriori (MAP) algorithm, Maximum likelihood (ML)-based reconstruction algorithms require some form of noise smoothing. Constrained ME provides a more formal method of noise smoothing without requiring the user to select parameters. In the context of SPECT, constrained ME seeks the minimum-information image estimate among those whose projections are a given distance from the noisy measured data, with that distance determined by the magnitude of the Poisson noise. Images that meet the distance criterion are referred to as feasible images, We find that modeling of all principal degrading factors (attenuation, detector response, and scatter) in the reconstruction is critical because feasibility is not meaningful unless the projection model is as accurate as possible. Because the constrained ME solution is the same as a MAP solution for a particular value of the MAP weighting parameter, beta, the constrained ME solution can be found with a MAP algorithm if the correct value of beta is found. We show that the RBI-MAP algorithm, if used with a dynamic scheme for estimating beta, can approximate constrained ME solutions in 20 or fewer iterations, We compare results for various methods of achieving feasible images on a simulation of Tl-201 cardiac SPECT data. Results show that the RBI-MAP ME approximation provides images and quantitative estimates close to those from a slower algorithm that gives the true ME solution, Also, we find that the ME results have higher spatial resolution and greater high-frequency noise content than a feasibility-based stopping rule, feasibility-based tow-pass filtering, and a quadratic Gibbs prior with beta selected according to the feasibility criterion. We conclude that fast ME approximation is possible using either RBI-MAP with the dynamic procedure or a feasibility-based stoppi

关键词：算法计算机模拟熵心脏/放射性核素显像图像处理计算机辅助/方法体模显象术体层摄影术发射型计算机单光子人类男(雄)性

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