대한핵의학회지 (The Korean Journal of Nuclear Medicine)

대한핵의학회 (The Korean Society of Nuclear Medicine)
권호 표지

급성심근경색증의 일차적 관동맥성형술 후 조기 Tl-201 재분포영상을 이용한 구조심근 예측

Prediction of Salvaged Myocardium in Patients with Acute Myocardial Infarction after Primary Percutaneous Coronary Angioplasty using early Thallium-201 Redistribution Myocardial Perfusion Imaging

  • 최준영 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 양유정 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 최승진 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 여정석 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 박성욱 (울산대학교 의과대학 서울아산병원 내과) ;
  • 송재관 (울산대학교 의과대학 서울아산병원 내과) ;
  • 문대혁 (울산대학교 의과대학 서울아산병원 핵의학과)
  • Choi, Joon-Young (Departments of Nuclear Medicine Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yang, You-Jung (Departments of Nuclear Medicine Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Seung-Jin (Departments of Nuclear Medicine Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yeo, Jeong-Seok (Departments of Nuclear Medicine Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seong-Wook (Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Jae-Kwan (Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon, Dae-Hyuk (Departments of Nuclear Medicine Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2003.08.30
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초록

목적: 심근경색증 후 재관류술에 의해 구조된 심근의 범위는 중요한 예후 인자중의 하나이다. 급성심근경색증의 일차적 관동맥성형술 후 조기 Tl-201 재분포영상이 구조심근과 심근벽운동 호전을 예측할 수 있는지 알아보았다. 대상 및 방법: 흉통 발생 $5.2{\pm}2.8$시간에 급성심근경색증으로 일차적 관동맥성형술을 시행한 36명을 대상으로 관동맥성형술 후 $5.8{\pm}2.1$일에 디피리다몰 부하 -4 시간 재분포 Tl-201 SPECT 영상을 얻었다. Tl-201 재분포 영상은 좌심실을 16분절로 나누고, 각 분절의 섭취를 5등급으로 평가하였다. 심초음파는 내원 당시, 경색 후 7일, 30일, 7개월에 시행하였고, 구조심근 분절은 내원 당시 심초음파상 벽 운동 이상이 있으면서 30일 또는 7개월 심초음파에서 벽 운동이 호전된 분절로 정의하였다. 결과: 내원 당시 212분절에서 벽운동 이상을 보였다(저운동 41분절, 무운동 171분절). 이중 1개월에는 78분절(36.8%)에서, 7개월에는 97분절(45.8%)에서 벽 운동이 호전되어 구조심근으로 판정하였다. 구조심근을 찾는 Tl-201 재분포 영상의 수신자판 단특성곡선면적은 1개월에 대해서는 $0.79{\pm}0.03$, 7개월에 대해서는 $0.83{\pm}0.03$이었다. Tl-201 섭취 40%를 경계로 정할 때 재분포 영상의 구조심근을 찾는 예민도, 특이도는 1개월에서는 84.6%(66/68), 55.2%(74/134), 7개월에서는 87.6%(85/97), 64.3%(74/115)였다. 재분포영상에서 Tl-201의 섭취정도와 벽 운동의 호전될 확률은 서로 비례하는 경향을 나타내었다. 결론: 급성심근경색증의 일차적 관동맥성형술 후 10일 이내에 시행한 조기 Tl-201 재분포영상은 구조심근과 심근벽운동 호전 예측 판정에 높은 예민도로 유용하게 사용될 수 있는 검사이다.EX>$100{\mu}M$)는 각각 11.9배와 6.8배, K562(Adr) 세포에서($50{\mu}M$)는 각각 14.3배와 8배, K562(Vcr) 세포에서($10{\mu}M$)는 각각 7배와 5.7배 증가하였다. Cyclosporin A에 의한 MIBI와 tetrofosmin의 섭취율(30분)을 기저치(30분)와 비교해 본 결과 HCT15/CL02세포에서($50{\mu}M$)는 각각 10배와 2.4배, K562(Adr)세포에서($50{\mu}M$)는 각각 44배와 13배, K562(Vcr)세포에서($10{\mu}M$)는 각각 18.8배와 11.8배 증가하여, MIBI의 섭취율이 tetrofosmin보다 1.2배에서 4배정도 높게 나타났다. 결론: 이러한 결과로 보아 MIBI와 tetrofosmin은 다약제내성의 발현을 평가할 수 있는 방사성의약품으로 판단되며, 다약제내성 극복제의 효능평가에는 MIBI가 tetrofosmin보다 더 우수할 것으로 사료되나, 세포추에 따른 차이가 있을 수 있으므로 보다 많은 세포주에서의 추가적인 연구가 필요할 것이다.여 후 구한 MPD는 평균 $13.3{\pm}1.9GBq\;(9.7{\sim}16GBq)$ 이였고, 치료용량 방사성옥소 투여 후 구한 MPD는 평균 $13.8{\pm}2.1GBq(10.4{\sim}16.3GBq)$로 유의한 차이가 얻었으며 (p=0.20), 두 수치간에는 유의한 상관 관계가 있었다(r=0.8, p<0.0001). 7명의 환자에서 말초혈액림프구 중기염색체 분석법으로 MPD를 측정하였는데 혈액의 피폭선량은 $1.78{\pm}0.03Gy$였으며, 같은 환자에서 혈중 방사능소실곡선으로부터 구한 피폭선량은 $1.54{\pm}0.03Gy$로 유의하게 낮았으나 (p=0.01), 두

Purpose: The amount of salvaged myocardium is an important prognostic factor in patients with acute myocardial infarction (MI). We investigated if early Tl-201 SPECT imaging could be used to predict the salvaged myocardium and functional recovery in acute MI after primary PTCA. Materials and Methods: In 36 patients with first acute MI treated with primary PTCA, serial echocardiography and Tl-201 SPECT imaging ($5.8{\pm}2.1$ days after PTDA) were performed. Regional wall motion and perfusion were quantified with on 16-segment myocardial model with 5-point and 4-point scaling system, respectively. Results: Wall motion was improved in 78 of the 212 dyssynergic segments on 1 month follow-up echocardiography and 97 on 7 months follow-up echocardiography, which were proved to be salvaged myocardium. The areas under receiver operating characteristic curves of Tl-201 perfusion score for detecting salvaged myocardial segments were 0.79 for 1 month follow-up and 0.83 for 7 months follow-up. The sensitivity and specificity of Tl-201 redistribution images with optimum cutoff of 40% of peak thallium activity for detecting salvaged myocardium were 84.6% and 55.2% for 1 month follow-up, and 87.6% and 64.3% for 7 months follow-up, respectively. There was a linear relationship between the percentage of peak thallium activity on early redistribution imaging and the likelihood of segmental functional improvement 7 months after reperfusion. Conclusion: Tl-201 myocardial perfusion SPECT imaging performed early within 10 days after reperfusion can be used to predict the salvaged myocardium and functional recovery with high sensitivity during the 7 months following primary PTCA in patients with acute MI.

키워드

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