临床心血管分子显像.ppt

* * * Stress-redistribution 201Tl SPECT and 18F-FDG PET in 1 ischemic group patient. Anteroseptal wall with redistribution on 201Tl SPECT (black arrows) showed increased uptake on 18F-FDG PET (pink arrow). * Short axial images of Tl-201 myocardial scintigraphy and positron emission tomography with [18F]fluorodeoxyglucose (FDG). Exercise Tl-201 perfusion images showed slightly decreased uptake of the tracer in the septal wall (panels A), with redistribution 3 h later (panels B). Exercise [18F]FDG images showed increased uptake of the tracer in the subendocardial region of the septal wall, indicating subendocardial ischaemia (panels C). * * * * * * * Nuclear cardiology offers an additional modality for assessing myocardial viability in patients with LV dysfunction who are being considered for revascularization procedures: positron emission tomography (PET). PET imaging for viability assessment combines evaluation of the metabolic activity of myocardium with 18-F deoxyglucose (FDG) and myocardial perfusion imaging with N-13 ammonia or rubidium-82. A mismatch between perfusion and metabolism (reduced perfusion associated with a relative or absolute increase in FDG) indicates myocardial viability.1-3 To evaluate the ability of PET to predict survival and improvement in symptoms of heart failure,Di Carli et al studied 93 patients with angiographically documented CAD and a mean ejection fraction of 0.25 using FDG and N-13 ammonia.4 The patients were followed for an average of 13.6 month. Of the 93 patients, 50 were treated medically and 43 underwent revascularization. The study found that the presence of perfusion-metabolism mismatch predicted improvement in heart failure symptoms after revascularization (p0.001). Patients with mismatch who were revascularized had a higher survival rate than those treated medically (88% versus 50%, p=0.03), as shown here. Among patients treated medically, the annual survival probability was significantly lower among those with mismatc