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| Title | 急性心筋梗塞の経過観察における99mTc-MIBI心電図同期心筋SPECTの有用性 - 梗塞部集積改善の機序に関する検討 - |
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| Subtitle | 原著 |
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| Authors | 鳥羽正浩*, 石田良雄*, 福地一樹*, 下津順子*, 久米典彦*, 林田孝平*, 高宮誠*, 野口輝夫**, 伊藤彰**, 野々木宏** |
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| Authors(kana) | |
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| Organization | *国立循環器病センター放射線診療部, **国立循環器病センター心臓内科 |
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| Journal | 核医学 |
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| Volume | 35 |
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| Number | 4 |
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| Page | 219-227 |
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| Year/Month | 1998/4 |
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| Article | 原著 |
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| Publisher | 日本核医学会 |
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| Abstract | 「要旨」超急性期に再灌流療法に成功した心筋梗塞症例に対し99mTc-MIBI心電図同期SPECTを用いて経過観察を行い, 非心電図同期(non-gated; NG)像における梗塞部集積改善の機序について検討した. 急性心筋梗塞17例において99mTC-MIBI心電図同期SPECTを再灌流療法から約1週間後(急性期)と約1か月(亜急性期)に実施した. R-R間隔8分割にて収集した心電図同期SPECTデータより拡張末期(ED)像および収縮末期(ES)像を作成した. NG像, ED像, ES像における左室心筋のトレーサ分布を極座標表示し, 各局所8セグメントにおける集積度を %uptake として算出した. また各画像で局所集積の改善度を Δ%uptake (亜急性期の %uptake - 急性期の %uptake)として評価し, 左室造影における局所壁運動の改善の有無と比較検討した. 急性期に壁運動異常を認めた梗塞部53領域は, 亜急性期において左室造影上壁運動が改善した17領域(A群)と不変であった36領域(B群)に分けられた. NG像では梗塞部の %uptake の改善はA群において顕著で(61.6±10.0%から75.7±10.1%, p<0.0001) Δ%uptake も大きく(14.1±9.1%), B群では有意ではあるものの(57.7±18.3%から61.0±17.5%) Δ%uptake はわずか(3.3±5.9%)であった. ED像では梗塞部の %uptake は両群ともに有意な改善を示さず, NG像の %uptake の変化と一致しなかった. しかしES像はA群で58.4±11.8%から68.9±11.8%と有意に改善した(p<0.001)がB群では不変であり, これらはNG像の変化と一致し, 壁運動の変化をよく反映した. またA群の Δ%uptake の検討でNG像はES像との間に有意な相関(p<0.02)を示したが, ED像とは相関を示さなかった. 以上のようにNG像はED像よりもES像に一致した変化を示したことから, 急性梗塞における集積改善は血流改善よりも収縮能の改善により部分容積効果の影響が減少することに起因すると考えられた. 急性心筋梗塞における血流・機能の経時的な観察においては, 心電図同期心筋SPECTの利用が必要と考えられた. |
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| Practice | 臨床医学：一般 |
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| Keywords | 99mTc-MIBI, Gated SPECT, Acute myocardial infarction, Reperfusion |
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| English |
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| Title | Usefulness of ECG-Gated 99mTc-MIBI Myocardial SPECT in the Follow-up Study of Patients with Acute Myocardial Infarction |
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| Subtitle | Original Articles |
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| Authors | Masahiro TOBA*, Yoshio ISHIDA*, Kazuki FUKUCHI*, Yoriko SHIMOTSU*, Norihiko KUME*, Kohei HAYASHIDA*, Makoto TAKAMIYA*, Teruo NOGUCHI**, Akira ITOH**, Hiroshi NONOGI** |
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| Authors(kana) | |
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| Organization | *Department of Radiology, **Department of Internal Medicine, National Cardiovascular Center |
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| Journal | The Japanese Journal of nuclear medicine |
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| Volume | 35 |
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| Number | 4 |
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| Page | 219-227 |
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| Year/Month | 1998/4 |
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| Article | Original article |
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| Publisher | THE JAPANESE SOCIETY OF NUCLEAR MEDICINE |
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| Abstract | To clarify the background of the scintigraphic improvement in non-gated myocardial perfusion imaging for patients with acute myocardial infarction, we performed serial ECG-gated 99mTc-MIBI myocardial SPECT in 17 patients with acute myocardial infarction (AMI) receiving successful reperfusion therapy. ECG-gated myocardial SPECT and left ventriculography were performed at 1 week (acute phase) and 1 month (subacute phase) after the onset of AMI. Regional %uptake (regional count×100/maximal count) was determined for each of 8 myocardial segments of the Bull's eye map. We analyzed the data in 53 AMI segments out of total 136 myocardial segments, on the non-gated (NG), end-diastolic (ED), and end-systolic (ES) images. In addition, the Δ%uptake (%uptake in subacute phase - %uptake in acute phase) was also determined as an index representing the improvement of myocardial tracer uptake on each image. In 17 segments (group A) with wall motion recovery assessed by serial left ventriculography, the %uptake on the NG image was significantly improved (61.6 +- 10.0 to 75.7 +- 10.1, p < 0.0001). However, in 36 segments (group B) without wall motion recovery, the change of %uptake on the NG image was small. There was no significant change in the %uptake on the ED image in groups A and B. On the contrary, the %uptake on the ES image showed a significant increase in group A (58.4 +- 11.8 to 68.9 +- 11.8, p < 0.001), but did not in group B. Thus, this change on the ES image reflects the wall motion recovery. Furthermore, in group A, there was a significant correlation between the Δ%uptake on the NG image and those on the ES image (p < 0.02), but was not between those on the NG and the ED images. Thus, the change in the %uptake on the NG image was more related to those on the ES image which is more affected by the change in regional wall motion than those on the ED image which reflects improved myocardial perfusion. These results suggest that ECG-gated myocardial 99mTc-MIBI SPECT is more useful to assess the serial change in myocardial perfusion and contraction than the conventional non-gated SPECT in the follow-up study of patients with AMI. |
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| Practice | Clinical medicine |
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| Keywords | 99mTc-MIBI, Gated SPECT, Acute myocardial infarction, Reperfusion |
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