대한핵의학회지 (1967년~2009년)
대한핵의학회지 1996;30(4)493~9
원저 : 관상동맥 질환에서 우회로 수술 전 Tl - 201 휴식 - 24시간 지연 심근 관류 SPECT를 이용한 심근생존능의 평가 ( Viability Assessment with Tl - 201 Rest - 24 hour Delay Redistribution SPECT before Coronary Artery Bypass Graft in Coronary Artery Diseases )
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Author 윤석남(Seok Nam Yoon),이동수(Dong Soo Lee),김기봉(Ki Bong Kim),이원우(Won Woo Lee),정준기(June Key Chung),이명철(Myung Chul Lee),서정돈(Jung Don Seo),고창순(Chang Soon Koh),
Affiliation
Abstract

To assess contribution of T1-201 rest-24 hour delay redistribution in detection of viable myocardium, we studied the predictive value of this redistribution in 17 patients who performed rest-24 hour delay perfusion SPECT before bypass surgery. Regional wall motion was compared with gated SPECT in 10 patients and echocardiography in 7 patients before and after bypass surgery. Rest and 24 hour delayed uptakes were scored from 0 (normal perfusion) to 3 (defect). In rest SPECT, 56 segments showed perfusion decrease. Thirty four segments(61%) improved after surgery and were defined as viable. Nineteen(34%) segments had more uptake of T1-201 at 24 hour delay, and the other 37 segments did not. In 81%(25/31) of segments with mildly decreased perfusion, wall motion after bypass surgery improved, 57% (8/14) of segments with severely decreased perfusion improved, and 9%(1/11) of segments with defects improved. In 14 among 19 segments which had more T1-201 uptakes at 24 hour delay, wall motion was improved (positive predictive value of redistribution: 74%). 20 among 37 segments which had persistent decreases in rest-24 hour redistribution improved and 17 did not(negative predictive value: 46%). Segments having severe perfusion decrease or defects showed improved wall motion after surgery in 64%(7/11), if it had redistribution at delay. Segments with either mildly decreased uptake in resting or rest-delayed redistribution showed improved wall motion in 76% (32/42). Among the 14 segments which showed improvement in wall motion, 10 had partial reversibility in stress- rest images and the other 4 had persistent perfusion defects in stress-rest images. These 4 segments were found viable only with rest-24 hour delayed perfusion SPECT. We concluded that rest T1-201 uptake or redistribution at 24 hour delay should be referred as an evidence to warrant postoperative improvement of abnormal wall motion and we could predict mycardial viability with preoperative rest-24 hour delay perfusion SPECT in the segments with rest perfusion decreases

Keyword Coronary artery bypass graft, Viability, Tl-201 rest-24 hour delay SPECT, Redistribution
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