Japanese
Title急性心筋梗塞における99mTc-PYP心筋シンチグラフィーの臨床的有用性と限界 - 心筋梗塞面積の評価を中心に -
Subtitle原著
Authors近藤武*, 桐山卓三*, 加藤善久*, 高亀良治*, 金子堅三*, 菱田仁*, 水野康*, 江尻和隆**, 河合恭嗣**, 竹内昭**, 古賀佑彦**
Authors(kana)
Organization*名古屋保健衛生大学内科, **放射線科
Journal核医学
Volume19
Number6
Page871-879
Year/Month1982/7
Article原著
Publisher日本核医学会
Abstract「要旨」99mTc-ピロリン酸心筋シンチ(PYPシンチ)を施行した76例(心筋梗塞66例, その他の疾患10例)を対象として急性心筋梗塞におけるPYPシンチの臨床的有用性と限界について検討した. 視覚的にPYPシンチ像を集積の程度によりgrade-0〜IIIの4群に分けgrade-I〜IIIを梗塞ありとした. PYPシンチ撮像の最適時期は梗塞発症7日以内で, そのsensitivityは91.4%, specificityは90.0%であった. grade分類からmaximum serum CPK value(max. CPK)を推定することは困難であり, max. CPKが300mU/ml以上ではPYPシンチにより全例で梗塞巣を検出できたが, max. CPKが300mU/mlに満たない梗塞群ではsensitivityは26.3%と低かった. 99mTc-PYPの集積部が最大となる方向でその辺縁をトレースして求めた梗塞面積とmax. CPKは前壁および側壁梗塞群と純下壁梗塞群を合わせた群でr=0.57, 前壁および側壁梗塞群でr=-0.69の有意な正相関を認めたが, 純下壁梗塞群では有意な相関は認められなかった. 下壁梗塞30例中8例(26.7%)においてPYPシンチにより右室梗塞の合併を診断し得, ことに血行動態上の所見(中心静脈圧および肺動脈楔入圧)だけでは診断困難であった2例において右室梗塞の診断が可能であり, PYPシンチは右室梗塞の診断にきわめて有用であった.
Practice臨床医学：一般
Keywordstechnetium-99m pyrophosphate myocardial scintigraphy, acute myocardial infarction, infarct area, right ventricular infarction, clinical study.
English
TitleReliability and Limitation of Technetium-99m Pyrophosphate Myocardial Scintigraphy in Assessment of Acute Myocardial Infarction
Subtitle
AuthorsTakeshi KONDO*, Takuzo KIRIYAMA*, Yoshihisa KATO*, Yoshiharu KOGAME*, Kenzo KANEKO*, Hitoshi HISHIDA*, Yasushi MIZUNO*, Kazutaka EJIRI**, Kyoji KAWAI**, Akira TAKEUCHI**, Sukehiko KOGA**
Authors(kana)
Organization*Department of Internal Medicine and **Department Radiology, Fujita-Gakuen University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume19
Number6
Page871-879
Year/Month1982/7
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary]Technetium-99m pyrophosphate (PYP) myocardial scintigraphy was performed in 76 patients(pts). Sixty-six pts had clinical, electrocardiographic and enzymatic evidences of acute myocardial infarction (AMI). PYP scintigrams were graded zero to III, depending on the radioactivity over the myocardium, and the grade I-III were regarded as abnormal. The appropriate timing of PYP scintigraphy determined by the relationships between days after the onset of AMI, the number of pts with each grade and the maximum serum CPK values (max. CPK) was within seven days after onset of AMI. Sensitivity and Specificity of PYP scintigram was 91.4 and 90.0 percent in 68 pts in whom PYP scintigraphy was performed during that period. It was impossible to deduce the max. CPK by the grade of PYP scintigram. In pts with AMI who had max. CPK lower than 300 mU/ml, the sensitivity of PYP scintigram was very low. The infarct size was estimated by planimetry of the area of abnormal PYP uptake in the projection which demonstrated the largest area of abnormal PYP uptake. The infarct area in pts with both anterior and/or lateral infarction and inferior infarction and in pts with only anterior and/or lateral infarction was significantly correlated with the max. CPK (r=0.57, r=0.69, respectively), while not in pts with only inferior infarction. Eight of 29 pts (27.6%) with inferior infarction showed abnormal PYP uptake of right ventricule (RV). Two of those eight pts failed to be diagnosed as RV infarction based on hemodynamic criteria (central venous pressure>=pulmonary capillary wedge pressure).
PracticeClinical medicine
Keywordstechnetium-99m pyrophosphate myocardial scintigraphy, acute myocardial infarction, infarct area, right ventricular infarction, clinical study.

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