Japanese
Title閉塞性動脈硬化症における99mTc-tetrofosmin運動負荷下肢シンチグラフィ - 動態像に認められる一過性軟部描出亢進現象と虚血下肢高集積像の病態解析 -
Subtitle原著
Authors木島鉄仁*, 汲田伸一郎*, 趙圭一*, 隈崎達夫*
Authors(kana)
Organization*日本医科大学放射線科
Journal核医学
Volume35
Number5
Page305-313
Year/Month1998/6
Article原著
Publisher日本核医学会
Abstract「要旨」間欠性跛行を主訴とする閉塞性動脈硬化症21症例を対象に, 運動負荷4分後に 99mTc-tetrofosmin 370-555 MBq の投与を行い, 下肢筋軟部集積像の撮像に加え, 静注直後における動態像をも撮像し, 2種の画像を結びつけた解析を行うことにより, 虚血肢の検出および下肢血流の評価を試みた. 全身背面像における下肢全体の Affected Normal Ratio (ANR) は0.97±0.12で虚血肢を高集積肢として検出することは困難であったが, 足部ANRは0.82±0.14を示し, 1例(4.8%)を除き虚血肢足部において低集積を示した. 動態像では虚血肢のみに一過性大腿軟部描出亢進現象(9例42.9%)を認め, 下肢虚血を示す診断意義の高い所見と考えられた. 動脈描出不良, 一過性大腿軟部描出亢進, 静脈早期描出の各所見による動態像における虚血肢検出能は sensitivity 71.4%, positive predictive value 93.8%を示し, さらに全身背面像上の足部集積低下とによる総合評価を行うと sensitivity は85.7%に改善した. 動態像から下肢通過時間を算出したところ, 虚血肢(12.0±3.1秒)は対側肢(17.3±4.5秒)と比較し有意に短時間であり(p<0.0001: paired t-test), また一過性大腿軟部描出亢進を示した虚血肢の大腿部は有意に高集積を示した. これらの結果は, 虚血肢では負荷後の高血流状態が遷延していることを反映しており, 下肢高集積は血流の増大を示唆すると考えられた. しかし虚血肢には低集積を示す部位も存在し, 末梢循環は複雑な調節下にあることも推測された. 本シンチグラフィは虚血肢の診断に有用なだけではなく, 下肢各部の末梢循環を把握しうる検査と考えられた.
Practice臨床医学：一般
KeywordsPeripheral vascular disease, Leg perfusion scintigraphy, RI angiography, Blush phenomenon, Early venous return
English
Title99mTc-Tetrofosmin Exercise Leg Perfusion Scintigraphy in Arteriosclerosis Obliterans (ASO) - Assessment of Leg Ischemia Using Two Phase Data Acquisition -
SubtitleOriginal Articles
AuthorsTetsuji KIJIMA, Shin-ichirou KUMITA, Keiichi CHO, Tatsuo KUMAZAKI
Authors(kana)
OrganizationDepartment of Radiology, Nippon Medical School
JournalThe Japanese Journal of nuclear medicine
Volume35
Number5
Page305-313
Year/Month1998/6
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
AbstractTwenty-one patients with arteriosclerosis obliterans (ASO) were studied with 99mTc-tetrofosmin exercise leg perfusion scintigraphy using the delayed administration method. In this method, tracer was injected 4 minutes after termination of symptom-limited repetitive climbing of a stair to validate prolonged vasodilatation in an ischemic lower limb after exercise. Visual and quantitative analyses were performed to evaluate a diseased leg using dynamic and static images. On a posterior whole body image, all cases except one showed decreased foot uptake in the affected side (affected normal ratio; ANR = 0.82 +- 0.14). On dynamic images, 9 cases showed transient hyper-accumulation (blush phenomenon) only in the thigh of the affected side suggesting that this valuable finding may be a useful diagnostic sign to distinguish a diseased leg. Sensitivity and positive predictive value were 71.4% and 93.8% to detect a diseased leg based on more than one finding of non-visualization of ilio-femoral artery, muscle-soft tissue blush, and early venous return in a dynamic study. Moreover, a low uptake of ANR of below 0.90 in the foot in the static study gave an improved sensitivity of 85.7%. The transit time of the diseased legs (12.0 +- 3.1 sec.) which was determined as the interval between the time of arterial and venous peak counts was significantly shorter than that of normal legs (17.3 +- 4.5 sec.; p < 0.0001, paired t-test). The cases with blush phenomenon showed significantly higher thigh ANR (1.04 +- 0.11) than those without (0.94 +- 0.08; p < 0.05, unpaired t-test). These results could reflect prolongation of a hypervascular state after exercise in a diseased leg which sometimes induced blush phenomenon at arterial phase and high leg uptake at static phase. This scintigraphy is useful for the detection of a diseased leg as well as for grasping changes of vascular regulation after stress in patients with ASO.
PracticeClinical medicine
KeywordsPeripheral vascular disease, Leg perfusion scintigraphy, RI angiography, Blush phenomenon, Early venous return

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