Japanese
Title運動負荷201Tl心筋シンチ断層法におけるDiffuse Slow Washout Patternの意義
Subtitle原著
Authors成田充啓*, 栗原正*, 村野謙一*, 宇佐美暢久*, 本田稔**
Authors(kana)
Organization*住友病院内科, **住友病院アイソトープ検査部
Journal核医学
Volume28
Number7
Page691-699
Year/Month1991/7
Article原著
Publisher日本核医学会
Abstract「要旨」運動負荷・再分布時201Tl心筋シンチ断層像で201Tl washout rateが左室全域で低下するdiffuse slow washout pattern (DSWO) の臨床的意義を検討した. 201Tl washout rate (3時間) はBull's-eye法で求め, すべての冠動脈領域の2/3以上に30%未満の部分が存在する時DSWOありと判定した. 201Tl静注時心拍数が120/分以上の974例中51例 (5.2%) にDSWOがみられ, 43例で冠動脈造影を施行, 三枝病変 (3VD) 23例 (53%), 一枝または二枝病変 (1VD / 2VD) 8例 (19%), 冠動脈狭窄の無い症例は12例 (28%) で内6例は肥大型心筋症 (HCM), 5例は高血圧 (HT), 1例は心電図上左室肥大を示す症例であった. 病歴, 心筋シンチでの欠損, 肺・心筋201Tl取り込み比等からの検討は, 3VDでは冠狭窄に基づく左室全域での虚血が, 1VD / 2VDでは負荷時左心機能障害が, HCMでは微小循環レベルでの虚血が, HTでは負荷時左心機能障害や微小循環レベルでの虚血がDSWOの原因と考えられ, 臨床上注目すべき所見と思われた.
Practice臨床医学：一般
KeywordsMyocardial SPECT, Exercise stress, Thallium-201, Diffuse slow washout, Bull's-eye method.
English
TitleClinical Implications of Diffuse Slow Washout of Thallium-201 in Exercise Stress Myocardial SPECT
SubtitleOriginal Articles
AuthorsMichihiro NARITA*, Tadashi KURIHARA*, Kenichi MURANO*, Masahisa USAMI*, Minoru HONDA**
Authors(kana)
Organization*Department of Internal Medicine, **Department of Nuclear Medicine, Sumitomo Hospital
JournalThe Japanese Journal of nuclear medicine
Volume28
Number7
Page691-699
Year/Month1991/7
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] Clinical implications of diffuse slow washout of thallium-201 (DSWO) in exercise-redistribution myocardial SPECT were studied. Thallium-201 washout rate was calculated by Bull's-eye method. DSWO was defined as having abnormal thallium-201 washout rate (< 30% per 3 hours) in more than two thirds of each coronary artery (CA) area. Of 974 patients whose exercise heart rate exceeded 120/min, 51 (5.2%) showed DSWO and coronary angiography was performed in 43. Twenty-three patients (53%) showed triple vessel disease (3VD), 8 (19%) showed single or double vessel disease (1VD / 2VD) and 12 (28%) showed normal CA. Patients with normal CA consisted of 6 patients with hypertrophic cardiomyopathy (HCM), 5 with hypertension (HT) and one with electrocardiographic abnormality only. The causes of DSWO were assessed from the history of effort angina (EA) and congestive heart failure (CHF), delayed fill-in of the perfusion defect and the ratio of lung to heart thallium-201 activity (L / M) at exercise as an indicator of the left ventricular (LV) function. High prevalence of EA (74%), high incidence of scintigraphic delayed fill-in (83%) and normal L / M suggested diffuse LV ischemia as the cause of DSWO in 3VD. On the other hand in patients with 1VD / 2VD, LV dysfunction at exercise was considered as the cause of DSWO because of low prevalence of EA (13%) and scintigraphic delayed fill-in (13%) (p < 0.01, p < 0.005 each vs 3VD), and high L / M (p < 0.001 vs 3VD) and high prevalence of CHF (38%, NS). In patients with HCM LV ischemia at small vessel levels was assumed as the cause of DSWO from the high incidence of EA (83%) and delayed fill-in (50%), low L / M and normal CA. In cases with HT LV dysfunction and / or LV ischemia at the small vessel levels were considered as the cause of DSWO. Thus it was concluded that DSWO is a noteworthy finding in exercise stress myocardial imaging.
PracticeClinical medicine
KeywordsMyocardial SPECT, Exercise stress, Thallium-201, Diffuse slow washout, Bull's-eye method.

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