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目的:观察肥厚型心肌病(HCM)患者的核素心肌灌注/代谢显像的变化,以进一步揭示HCM的病理生理改变,为今后患者的预后分析提供基础。方法:采用单光子发射计算机断层成像双核素心肌灌注/代谢显像的方法对93例(男65例,女28例,年龄16～68岁)HCM患者行~(99m)Tc-甲氧基异丁基异腈(~(99m)Tc-MIBI)心肌灌注显像和~(18)F-脱氧葡萄糖(~(18)F-FDG)心肌代谢显像。患者均为空腹状态下,静脉注射~(99m)Tc-MIBI 20 mCi、~(18)F-FDG 4 mCi,1小时后行双核素心肌显像。采用半定量评分法分析左心室室壁各节段的灌注及葡萄糖显像情况。结果:93例HCM患者~(99m)Tc-MIBI心肌灌注显像结果:左心室心肌放射性摄取增高患者90例(97%),其中间隔部82例,前壁20例,心尖部15例,外侧壁4例,下后壁3例。93例HCM患者~(18)F-FDG心肌代谢显像结果:31例(33%)患者心肌未见明显显影;13例(14%)患者左心室显影清晰,左心室室壁各心肌节段均可见放射性摄取或明显摄取(得分为-1或-2);49例(53%)患者心肌部分节段有放射性分布,其中间隔36例,前壁35例,心尖部20例,外侧壁33例,下后壁32例。结论:肥厚型心肌病患者心肌灌注/代谢显像异常表现具有多样性,灌注显像的异常主要表现为心肌放射性摄取增高,最多累及部位为间隔部;而代谢显像表现不均一性较为明显,左心室室壁各心肌节段约可见放射性摄取的患者有14%,心肌部分节段可见放射性摄取的患者有53%,而左心室心肌各节段均未见放射性摄取的占33%。
Objective: To observe the changes of radionuclide myocardial perfusion / metabolic imaging in patients with hypertrophic cardiomyopathy (HCM) so as to further reveal the pathophysiological changes of HCM and provide the basis for future prognosis analysis. Methods: Ninety-nine patients (65 males and 28 females, aged 16-68 years) with HCM were treated with ~ (99m) Tc-methoxyisosorbate by single photon emission computed tomography (DWI) myocardial perfusion / Myocardial perfusion imaging with ~ (99m) Tc-MIBI and ~ (18) F-deoxyglucose (~ (18) F-FDG) All patients underwent fasting, intravenous injection of ~ (99m) Tc-MIBI 20 mCi, ~ (18) F-FDG 4 mCi, and 1 h after transrenaline myocardial imaging. Semi-quantitative scoring method was used to analyze the perfusion and glucose imaging in all segments of left ventricular wall. Results: The results of 99m Tc-MIBI myocardial perfusion imaging in 93 patients with HCM showed that 90 patients (97%) had increased left ventricular myocardial radioactive uptake, including 82 cases of anterior wall, 20 anterior wall, 15 apex, 4 cases of wall, 3 cases of posterior wall. Myocardial metabolic imaging results of ~ (18) F-FDG in 93 patients with HCM showed no significant myocardial development in 31 patients (33%). Left ventricular manifestations were clear in 13 patients (14%), myocardial segments All of the 49 patients (53%) had radioactive distribution in some segments of the myocardium, including 36 cases in the interval, 35 cases in the anterior wall, 20 cases in the apex, 33 in the lateral wall For example, 32 cases of the posterior wall. Conclusions: Myocardial perfusion / metabolic imaging abnormalities in patients with hypertrophic cardiomyopathy are diverse. The main abnormalities of perfusion imaging are the increase of myocardial radioactive uptake and the most involvement of the site as the septum. However, the heterogeneity of metabolic imaging is more obvious, Left ventricular wall myocardial segments of about 14% of patients with radioactive ingestion, myocardial segments showed radioactive uptake of 53% of patients, and no segments of the left ventricular myocardium radioactive uptake accounted for 33%.