Japanese
Titleアドリアマイシン心筋症におけるGa-67心筋シンチグラフィの有用性
Subtitle症例報告
Authors両角隆一*, 石田良雄*, 谷明博*, 乾誠*, 田内潤*, 星田四郎*, 上松正朗*, 尾崎仁*, 佐藤洋*, 堀正二*, 北畠顕*, 鎌田武信*, 近藤博史**, 小塚隆弘**, 木村和文***
Authors(kana)
Organization*大阪大学医学部第一内科, **大阪大学医学部附属病院中央放射線部, ***大阪大学医学部バイオメディカル教育センター
Journal核医学
Volume27
Number5
Page477-484
Year/Month1990/5
Article報告
Publisher日本核医学会
Abstract「要旨」 アドリアマイシン心筋症の一例に対し, 心筋傷害の検出に有用な核医学的イメージング法の検討を行った. Tl-201心筋シンチ, I-123MIBGシンチ, Tc-99mPYPシンチを実施したところ, 心筋傷害を示唆する有意な所見が観察されなかった. しかし, Ga-67シンチにて心臓部位に陽性集積像を認め, また臨床症状が著しく改善した後の再検査では, Ga-67の陽性集積像は明らかな改善を示した. 以上, アドリアマイシンによる心筋傷害の検出と経過観察にGa-67シンチが有用であった一例を経験した. 「I. はじめに」 抗腫瘍剤として広く使用されているアドリアマイシン (ADM) は, 容量依存性の心筋毒性があり, 大量投与によって心不全を誘発する危険性がある. しかし, その心筋傷害の非侵襲的検出は難しいのが現状である. 今回われわれは, 乳癌の術後, 再発病変に対するADMの大量投与によって生じたと思われる二次性の拡張型心筋症例を経験し, 心筋傷害の検出に有用な核医学的心筋イメージングを検討した.
Practice臨床医学：一般
KeywordsAdriamycin cardiomyopathy, Gallium-67, I-123 metaiodobenzylguanidine (MIBG) , Thallium-201, Tc-99m pyrophosphate (PYP)
English
TitleGallium-67 Myocardial Imaging for the Detection of Adriamycin Cardiomyopathy
Subtitle
AuthorsTakakazu MOROZUMI*, Yoshio ISHIDA*, Akihiro TANI*, Makoto INUI*, Masatsugu HORI*, Akira KITABATAKE*, Takenobu KAMADA*, Hiroshi KONDO**, Takahiro KOZUKA**, Kazufumi KIMURA**
Authors(kana)
Organization*The first Department of Medicine, **Division of Nuclear Medicine, Osaka University Medical school
JournalThe Japanese Journal of nuclear medicine
Volume27
Number5
Page477-484
Year/Month1990/5
ArticleReport
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] To detect Adriamycin cardiomyopathy, radionuclide myocardial imagings with Tl-201, Tc-99m pyrophosphate, I-123 metaiodobenzylguanidine and Ga-67 were performed in a 49 year-old-woman receiving Adriamycin (a total dose of 230mg/m2) for the treatment of breast cancer. This patient demonstrated symptoms of congestive heart failure 2 months after the last intravenous administration. At the period of performing the radionuclide studies, echocardiographic LV ejection fraction (EF) was 22%. Despite severe deterioration of cardiac function, Tl-201 SPECT demonstrated no defect and Tc-99m pyrophosphate (PYP) SPECT demonstrated no positive finding. I-123 metaiodobenzylguanidine (MIBG) scintigraphy demonstrated no regional defect. However, I-123 MIBG washout rate during 4 hours was markedly enhanced, probably reflecting abnormalities of norepinephrine kinetics due to the progression of heart failure. Compared to these pharmaceuticals, Ga-67 was diffusely accumulated in the heart. Then, 5 months after the first study, when LV EF improved to 30% and congestive symptoms disappeared probably owing to β-blockde therapy, myocardial accumulation of Ga-67 markedly reduced. It has been reported that Ga-67 accumulates in malignant tumor cells and leukocytes. Since, in Adriamycin cardiomyopathy, myocardial accumulation of leukocytes with myocardial fibrotic changes have been histologically demonstrated, the results of Ga-67 scintigraphy may reflect the accumulation of leukocytes. Thus, this case indicates that Ga-67 scintigraphy is advantageous for detecting Adriamycin cardiomyopathy and may be more useful than Tl-201 and Tc-99m PYP scintigraphies.
PracticeClinical medicine
KeywordsAdriamycin cardiomyopathy, Gallium-67, I-123 metaiodobenzylguanidine (MIBG) , Thallium-201, Tc-99m pyrophosphate (PYP)

【全文PDF】