Original Articles 관상동맥질환에서 Adenosine 부하 Tc-99m Abstract Tetrofosmin SPECT 의진단적유용성 * 황진용 이재태 최지용 안병철 조용근채성철 전재은 박의현 이규보 ** 김윤년 조인호 Eval

Size: px

Start display at page:

Download "Original Articles 관상동맥질환에서 Adenosine 부하 Tc-99m Abstract Tetrofosmin SPECT 의진단적유용성 * 황진용 이재태 ** 최지용 안병철 ** 조용근채성철 전재은 박의현 이규보 ** 김윤년 조인호 Eval"

준서 위
4 years ago
Views:

1 Original Articles 관상동맥질환에서 Adenosine 부하 Tc-99m Abstract Tetrofosmin SPECT 의진단적유용성 * 황진용 이재태 ** 최지용 안병철 ** 조용근채성철 전재은 박의현 이규보 ** 김윤년 조인호 Evaluation of Coronary Artery Disease with Tc-99m Tetrofosmin SPECT in Conjuction with Intravenous Adenosine Jin Yong Hwang, M.D., Jaetae Lee, M.D.,** Ji Yong Choi, M.D., Byeong Cheol Ahn, M.D.,** Yong Keun Cho, M.D., Shung Chull Chae, M.D., Jae Eun Jun, M.D., Wee Hyun Park, M.D., Kyu Bo Lee, M.D.** Department of Internal Medicine and Nuclear Medicine,** School of Medicine, Kyungpook National University, Taegu, Korea Yoon Nyun Kim, M.D. Department of Internal Medicine, School of Medicine, Keimyung University, Taegu, Korea In Ho Cho, M.D. Department of Nuclear Medicine, School of Medicine, Youngnam University, Taegu, Korea BackgroundTc-99m tetrofosmin is a recently developed myocardial perfusion agent that has shown promising characteristics, displaying rapid accumulation in and slow clearance from the myocardium with rapid clearance from background organs. Adenosine is relatively safe, direct and potent coronary vasodilator and has been used as a stress agent in myocardial perfusion scintigraphy. We have performed tetrofosmin single photon emission computed tomographyspect in patients suspected of coronary artery disease. This study was aimed to assess the safety profile and diagnostic accuracy of adenosine Tc-99m tetrofosmin SPECT. MethodOne hundred forty six patients underwent Tc-99m tetrofosmin SPECT with intravenous adenosine. Four hours after resting Tc-99m tetrofosmin SPECT imaging, adenosine was infused 30

2 intravenously at a dose of 0.14 mgkg of body weight per minute for 6 min and Tc-99m tetrofosmin was injected at 3 min after start of infusion. Blood pressure, heart rate and side effects was recorded during and after four minutes of adenosine infusion. Forty seven of patients underwent coronary angiography within 2 weeks. ResultsAdenosine induced a significant and mild decrease in systolic and diastolic blood pressure at 2 min after start of adenosine infusion and a significant and mild increase in heart rate after 1 min of infusion which was normalized after completion of infusion. Side effects were observed in 70% of 146 patients. Chest discomfort30%, mild dyspea25%, chest pain19%, and headach12% were common. No serious side effects were observed despite of continuation of infusion. Adenosine infusion was terminated prematurely in 2 patients due to intolerable chest pain and restlessness, respectively. The diagnostic sensitivity for detection of CAD50% and 70% coronary stenosis by coronary angiography by adenosine Tc-99m tetrofosmin SPECT were sensitivity 92%, 97%, and specificity 91%, 86%, and predictive accuracy 91%, 94%, respectively. The sensitivities for detection of individual coronary stenosis50% and 70% coronary stenosis by coronary angiography were 76%, 79% for LAD, 67%, 67% for LCX, and 73%, 82% for RCA, respectively. Specificities were 92%, 89% for LAD, 100%, 100% for LCX, 92%, and 87% for RCA. ConclusionAdenosine Tc-99m tetrofosmin SPECT appears to be a feasible, safe, highly sensitive and specific test for the diagnosis of coronary artery disease. KEY WORDSTc-99m tetrofosmin SPECT Coronary artery disease Adenosine. 서 론 Fig. 1. Molecular structure of tetrofosmin1,2-bisbis2- ethoxy-ethylphosphino]ethane. 31

3 대상및방법 1. 연구대상 2. 검사방법 (Study Protocol) Table 1. Characteristics of subjects in the 44 patients Ageyears 5611 MaleFemale History of MI No. of stenotic artery Stenosis 50% Stenosis 70% No VD VD VD Values in parentheses are percentage VDvessel disease Fig. 2. Same day Tc 99m tetrofosmin SPECT imaging. 32

4 4. 관상동맥조영술및판정 5. 통계 3. Tc-99m 심근 SPECT영상및판정 결과 1. 관상동맥조영술소견 Table 2. Hemodynamic effects of adenosine in the 146 patients Baseline Peak effect p Value Heart ratebeatmin P0.001 Systolic BPmmHg p0.01 Diastolic BPmmHg p0.001 Rate-pressure product p0.001 Values are meansstandard deviations BPblood pressure, rate-pressure productbeatesmin mmhg103 33

5 2. Adenosine 정주에따른혈역학의변화 3. Adenosine 정주에따른부작용 Table 3. Side effectsn146 Side effects Chest discomofort Dyspnea Chest pain Headache Neck discomfort Facial flushing Palpitationv Nausea Dizzness Premature termination No side effects No. of patients%) Adenosine 부하 Tc-99m tetrofosmin SP- ECT 검사의관동맥질환진단능 Table 4. Diagnostic values in the detection of CAD Stenosis50% Stenosis70% Sensitivity Specificity PV PV PA Values in parenthesis are no. of patientspvpositive predictive valuepvnegative predictive valuepapredictive accuracy 34

6 Fig. 3. 근위좌전하행지 Proximal anterior descending artery에 90% 협착이있었던남자 52세협심증환자의 adenosine 부하 Tc-99m tetrofosmin SPECT 소견. Table 5. Diagnostic accuracy for the detection of individual stenotic artery Stenosis50% Stenosis70% Sensitivity% Specificity% )PV%) )PV%) PA%) Values in parenthesis are no. of patientspvpositive predictive valuepvnegative predictive valuepapredictive accuracy 5. Adenosine 부하 Tc-99m tetrofosmin SPECT 검사의개개관동맥분지별협착발견의진단능 35

7 Table 6. Diagnostic values in localizing stenotic artery LAD LCX RCA 50% 70% 50% 70% 50% 70% Sensitivity Specificity PV PV PA LAD left anterior descending artery LCX left circumflex artery RCA right coronary artery Values in parenthesis are numbers of patientspvpositive predictive valuepvnegative predictive valuepapredictive accuracy 고찰 36

8 37

9 요약 연구배경 : 38

10 연구방법 : 결과 : 결론 : References 1) Kiat H, Maddahi J, Roy LT, Train KV, Friedman J, Resser K, Berman DS:Comparison of Tc-99m methoxy isobutyl isonitrile with thallium-201 imaging by planar and SPECT techniques for assessment of coronary disease. Am Heart J 117:1-11, ) Sridhara BS, Braat S, Rigo P, Itti R, Cload P, Lahiri A: Comparision of myocardial perfusion imaging with technetium-99m-tetrofosmin versus thallium-201 in coronary artery disease. Am J Cardiol 72: , ) Hendel RC, McSherry B, Karimeddini M, Leppo JA: Diagnostic value of new myocardial perfusion agent, teboroxime(sq 30217), utilizing a rapid planlar imaging protocol:preliminary results. J Am Coll Cardiol 16: , ) Wackers FJ, Berman DS, Maddahi J, Watson DD, Beller GA, Strauss HW, Boucher CA, Picard M, Holman BL, Friedrich R, Inglese E, Delaloye B, Bischop-Delaloye A, Camin L, McKusick K:Technetium-99m hexakis 2- methoxyisobutyl isonitrile:human biodistribution, dosimetry, safety and preliminary comparison to thallium- 201 for myocardial perfusion imaging. J Nucl Med 30: , ) Jain D, Wackers FJ, McMahon M, Zaret BL:Is there any redistribution with Tc-99m tetrofosmin imaging? A quantitative study using serial planar imaging[abstract]. Circulation 86:I-46, ) Higley B, Smith FW, Smith T, Gemmell HG, Gupta PD, Gvozdanovic DV, Graham D, Hinge D, Davidson J, Lahiri A:Technetium-99m-1,2-bis[bis(2-ethoxyethyl)phosphino] ethane:human biodistribution, dosimetry and safety of a new myocardial perfusion imaging agent. J Nucl Med 34:30-38, ) Kelly JD, Foster AM, Higley B, Archer CM, Booker FS, Canning LR, Chiu KW, Edwards B, Gill HK, McPartlin M:Technetium-99m-tetrofosmin as a new radiopharmaceutical for myocardial perfusion imaging. J Nucl Med 34: , ) Jain D, Wakers FJ, Mattera J, McMahon M, Sinusas AJ, Zaret BL:Biokinetics of technetium-99m-tetrofosmin: Myocardial perfusion imaging agent:implications for a one-day imaging protocol. J Nucl Med 34: , ) Beer S, Heo J, Askenase A, Segal BL, Auerbach N: Dipyridamole cardiac imaging. Am Heart J 115: ,

11 10) Lee SC, Lee BR, Chae SC, Jun JE, Park WH, Lee JT, Lee KB, Kim KS, Kim YN, Kim KB:Diagnostic value of Tc-99m MIBI myocardial perfusion scintigarphy during maximal coronary artery dilatation with adenosine in coronary artery disease. Korean Cir J 22;6: , ) Iskandrian AS, Heo J, Askenase A, Segal BL, Auerbach N:Dipyridamole cardiac imaging. Am Heart J 115: , ) Ranhosky A, Kempthorne-Rawson J:The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Circulation 81: , ) Homma S, Gilliland Y, Guiney TE, Strauss HW, Boucher CA:Safety of intravenous dipyridamole for stress testing with thallium imaging. Am J Cardiol 59: , ) Wilson RF, Wyche K, Christemsen BW, Zimmer S, Laxson DD:Effects of adenosine on human coronary arterial circulation. Circulation 82: , ) Lee JT, Chung BC, Choi JI, Kwak DS, Lee KB, Chae SC:Myocardial uptake and clearance of thallium-201 in normal subjects:a comparision between pharmacologic stress with intravenous adenosine, dipyridamol and dobutamine and exercise stress testing. Korean J Nucl Med 27;1:35-50, ) Zaret BL, Rigo P, Wakers FJ, Hendel RC, Braat SH, Iskandrian AS, Sridhara BS, Jain D, Itti R, Serafini AN, Goris ML:Myocardial perfusion imaging with Tc-99m tetrofosmin:comparison to Tl-201 imaging and coronary angiography in a phase Ⅲ multicenter trial. Circulation 91: , ) Mahmood S, Gunning M, Bomanji JB, Gupta NK, Costa DC, Jarritt PH, Swanton H, Ell PJ:Combined rest Thallium-201/stress Technetium-99m tetrofosmin SPECT : Feasibility and diagnostic accuracy of a 90-minute protocol. J Nucl Med 36: , ) Nakajima K, Taki J, Shuke N, Bonki H, Takata S, Hisada K:Myocardial perfusion imaging and dynamic analysis with Technetium-99m tetrofosmin. J Nucl Med 34: , ) Tamaki N, Takahashe N, Kawamoto M, Torizuka T, Tadamura E, Yonekura Y, Okuda K, Nohara R, Sasayama S, Konishi J:Myocardial tomography using Technetium-99m tetrofosmin to evaluate coronary artery disease. J Nucl Med 35: , ) Powers J, Lerakis S, Aksut S, Cave V, Cassel D, Heo J, Iskandrian AS:SPECT Tc-99m tetrofosmin imaging during dipyridamole induced coronary hypermia(abstract). J Am Coll Cardiol 255A, ) Flamin P, Bossuyt A, Franken PR:Technetium-99m-tetrofosmin in dipyridamole stress myocardial SPECT imaging:intraindividual comparison with Technetium-99msestamibi. J Nucl Med 36: , ) Bodenheimer MM, Banka VS, Fouch CM, Helfant RH: Comparative sensitivity of the exercise electrocardiogram, thallium imaging and stress radionuclide angiography to detect the presence and severity of coronary artery disease. Circulation 60: , ) Nguyen T, Heo J, Ogilby JD, Iskandrian AS:Single photon emission computed tomography with thallium 201 during adenosine-induced coronary hyperemia:correlation with coronary arteriography, exercese thallium imaging and two-dimensional echocardiography. J Am Coll Cardiol 16: , ) Unlu M, Turgut B, Gunaydin S, Atavci S, Gokgoz L: Dobutamine tetrofosmin SPECT in the detection of coronary artery disease:evaluation of a same day rest-stress protocol(abstract). J Nucl Med 36;5:132P, ) Verani MS:Adenosine thallium 201 myocardial perfusion scintigraphy. Am Heart J 122: , ) Kinoshita S, Yamashita S, Suzuki T, Muramatzu T, Ide M, Dohi Y, Nishimura K, Miyamae T:Thallium-201 myocardial scintigraphy after intravenous infusion of adenosine triphosphate disodium:a preliminary study in the diagnosis of coronary artery disease(abstract). Kaku-Igaku 28;12: , ) Mohiuddin SM, Esterbrooks DJ, Gupta NC, Hilleman DE:Safety of different dosages of intravenous adenosine used in conjunction with diagnostic myocardial imaging techniques. Pharmacotherapy 13;5:476-80, ) Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS:Safety profile of adenosine stress perfusion imaging:results from the adenoscan multicenter trial registry. J Am Coll Cardiol 23:384-9, ) Wakers FJ:Adenosine or Dipyridamole:Which is preferred for myocardial perfusion imaging? J Am Coll Cardiol 17:6:1295-6, ) Sinusas AL, Shi QX, Saltzberg PI, Chang Pj, Vitols D, Wackers BL:Technetium-99m tetrofosmin for assessment of myocardial perfusion:initial distribution and clearance, relationship to blood flow(abstract). J Nucl Med 33;5:993, ) Braat S, Leclerq B, Itti R, Lahiri A, Rigo P:Myocardial perfusion imaging with tetrofosmin:comparision between a one and a two day protocol(abstract). J Am Coll Cardiol 21;2:251A, ) Taillefer R, Gagnon A, Laflamme L, Gregoire J, Leveille J, Phaneuf D:Same-day injections of Tc-99m methoxy isobutyl isonitrile(hexamibi) for myocardial tomographic imaging:comparision between rest-stress and stress-rest injection sequences. Eur J Nucl Med 15: , ) Bair HJ, Behr TM, Feistel H, Becker W, Altstidle R, Wolf FG:Tc-99m tetrofosmin as a myocardial perfusion agent. Tracer biokinetics and comparision with quantitative coronary angiography(abstrsct). J Nucl Med 36; 5:133P, ) Imai K, Askawa K, Hoshino H, Shibata T, Ogawa Y, Kubouchi Y, Horie T:Usefulness of simultaneous func- 40

12 tion and perfusion imaging of Tc-tetrofosmin myocardial scintigraphy(abstract). J Nucl Med 36;5:100P, ) Van Train KF, Garcia EV, Maddahi J, Areeda J, Cooke CD, Kiat H, Silagan G, Folks R, Freadman J, Matzer L:Multicenter trial validation for quantitative analysis of same-day rest-stress technetium-99m-sestamibi myocardial tomograms. J Nucl Med, 35;4: , ) Topol EJ, Nissen SE:Our preoccupation with coronary luminology-the dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 92: ,

황지웅

황지웅 Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic