【摘要】 目的使用DISA心肌存活显像的方法,对粒-巨噬细胞集落刺激因子(GM-CSF)动员外周血干细胞辅助治疗急性心肌梗死患者的安全性及近期临床疗效进行评价。方法选取我院心内科收住的急性心肌梗死患者20例(均为男性),随机分为用药组(10例)和对照组(10例)。显像前,于静息状态下静脉注射99mTc-MIBI 925 MBq,调整血糖水平至7.8～8.8 mmol/L,1 h后静脉注射18F-FDG296 MBq,45～60 min后进行显像。采用Millinium VG+Hawkeye双探头hPET/CT仪,分别使用两个能窗[(140±20)kev;(511±30)kev]对99mTc-MIBI和18F-FDG同时采集(步进式采集,1帧/3,共采集60帧)。常规断层重建,同时获得99mTc-MIBI和18F-FDG图像。采用心肌20分区评分法判断心肌存活情况;对比灌注、代谢缺损面积。结果20例患者共检出心肌存活8例,检出率为40%,其中对照组2例、用药组6例(P<0.05)。用药组99mTc-MIBI靶心图缺损面积为40.00±13.36,18F-FDG图像缺损面积为33.33±9.30,后者较前者明显减小,提示存活心肌增加;对照组99mTc-MIBI靶心图缺损面积为38.40±13.54,18F-FDG图像缺损面积为37.45±14.84,后者与前者比较无明显变化,提示存活心肌未见增加。结论一日法DISA心肌灌注/代谢显像,能全面评价冠心病患者的心肌灌注及存活状况,可作为评价急性心肌梗死患者GM-CSF治疗后疗效的重要手段之一。更多还原

【Abstract】 Objective To evaluate the safety and immediate clinical efficacy of granulocyte-macrophage colony-stimulating factor(GM-CSF) mobilized peripheral blood stem cells(PBSCs) in adjuvant treatment of patients with acute myocardial infarction(AMI) using 99mTc-MIBI/18F-FDG dual isotope simultaneous acquisition(DISA).Methods We studied 20 male patients admitted to our department for AMI,with 10 in medication group [mean age of (59.8±2.58) years] and 10 in control group [ mean age of(54.3±.95) years].Their blood sugar level was adjusted to 7.8-8.8mmol/L when 99mTc-MIBI 925 MBq was injected intravenously under resting state.After one hour,18F-FDG 296 MBq was injected intravenously and images were taken 45-60 minutes later.DISA was performed using a dual-head hPET/CT system(Millinium VG+Hawkeye,GE) equipped with ultra-high energy collimators [(140±20)kev,(511±30)kev].Stepping acquisition was adopted with 1 frame/3s,and a total of 60 frames were collected.Conventional reconstruction of the 99mTc-MIBI and 18F-FDG images was done simultaneously after acquisition.Myocardial 20 division scoring method was used to compare and score the perfusion/metabolic 20 division polar bulls eye plot.The perfusion and metabolic defect areas were also compared.Results In 8 out of 20 patients myocardial metabolic imaging showed areas of survivable myocardium,detection rate being 40%.Among the 8 cases,2 were from control group and 6 from medication group(P<0.05).Scoring of the perfusion/metabolic polar bulls eye plot showed that the mean defect area was 40.00±13.36 in 99mTc-MIBI imaging and 33.33±9.30 in 18F-FDG imaging in medication group.The defect area was obviously smaller in 18F-FDG imaging,indicating higher myocardial viability.In contrast,the corresponding indexes in control group were 38.40±13.54 and 37.45±14.84 with no significant difference,which indicated that survivable myocardium was not found increased.Conclusion The same-day protocol of DISA imaging study can make an overall appraisal of myocardial perfusion and survival status.Thus it can be used as an important method for evaluating the efficacy of GM-CSF therapy in AMI patients.更多还原