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 ) () |
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), |
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Affiliation |
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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 |
Full text Article |
28501813.pdf
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