Nichtinvasive Bestimmung der myokardialen Ruhedurchblutung mit 82Rb PET bei Patienten im Vergleich zur Argon-Methode

S. N. Reske; M. M. Henrich; E. Mate; R. Weller; G. Glatting; S. Grimmel; R. Weismüller; J. Stollfuß; V. Hombach

doi:10.1055/s-0038-1632290

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 1993; 32(06): 276-281
DOI: 10.1055/s-0038-1632290

Originalarbeit

Schattauer GmbH

Nichtinvasive Bestimmung der myokardialen Ruhedurchblutung mit ⁸²Rb PET bei Patienten im Vergleich zur Argon-Methode

Non-Invasive Detection of Resting Myocardial Blood Flow with ⁸²Rb PET in Patients Compared to the Argon Method

S. N. Reske

,

M. M. Henrich

,

E. Mate

,

R. Weller

,

G. Glatting

,

S. Grimmel

,

R. Weismüller

¹Aus der Radiologischen Klinik III, Nuklearmedizin, und der Medizinischen Klinik II Kardiologie, Universitätsklinikum Ulm, FRG

,

J. Stollfuß

,

V. Hombach

¹Aus der Radiologischen Klinik III, Nuklearmedizin, und der Medizinischen Klinik II Kardiologie, Universitätsklinikum Ulm, FRG

› Institutsangaben

Abstract

Zusammenfassung

In der vorliegenden Studie wurde eine Methode zur quantitativen myokardialen Ruhedurchblutungsmessung in absoluten Einheiten mit dem Generatornuklid ⁸²Rb und PET bei Patienten vorgestellt. Der auf dem Fickschen Prinzip basierende methodische Ansatz, der von Herrero und Mitarb. (Circulation 1990; 82: 1377-86) im tierexperimentellen Modell validiert wurde, lieferte bei 11 herzgesunden Patienten einen globalen Wert der linksventrikulären Myokarddurchblutung von 0,68 ± 0,10 ml/min/g Herzmuskelgewebe. Mit Ausnahme des apikalen Segmentes fanden sich in 12 linksventrikulären Myokardsegmenten keine signifikanten regionalen Unterschiede der Myokarddurchblutung. Bei 5 simultan mit der Argon-Methode und ⁸²Rb-PET-untersuchten Patienten wurde kein signifikanter Unterschied der Myokarddurchblutung zwischen der ⁸²Rb-PET-Messung und der Argonmethode beobachtet (0,60 ± 0,05 vs 0,68 ± 0,15 ml/min/g, n.s.). Diese Resultate zeigen, daß ⁸²Rb PET eine korrekte nichtinvasive quantitative Bestimmung der myokardialen Ruhedurchblutung auch bei Patienten erlaubt.

Summary

Resting myocardial blood flow in absolute units was determined in 11 patients without known heart disease using dynamic PET with ⁸²Rb. Based on a modified Fick’s approach to measuring myocardial blood flow, originally developed and validated in canine studies by Herrero and coworkers (Circulation 1990; 82: 1377-86), a global flow value of 0,60 ±0,10 ml/min/gr myocardium (MV±SD, N = 11) was obtained. With the exception of the apex, segmental blood flow was not significantly different in 12 left ventricular myocardial segments, indicating homogenous myocardial blood flow distribution. In 5 patients global myocardial blood flow was determined simultaneously both by ⁸²Rb PET and argon as inert gas method. ⁸²Rb flow did not differ significantly from argon flow (0,60 ± 0,05 vs. 0,68 ±0,15, MV ± SD, N.S.). These results show that correct quantitation of resting myocardial blood flow with dynamic ⁸²Rb PET is feasible also in patients.

Schlüsselwörter

Quantitative Myokarddurchblutung - ⁸²Rb-PET - Argon-Methode

Key words

Quantitation of myocardial blood flow - ⁸²Rb-PET - argon-inert gas method

Volltext

Referenzen

LITERATUR
1 Araujo LI, Lammcrtsma AA, Rhodes CG. et al. Noninvasive Quantification of Regional Myocardial Blood Flow in Coronary Artery Disease With Oxygen-15-Labcled Carbon Dioxide Inhalation and Positron Emission Tomography. Circulation 1991; 83: 875-85.
2 Bergmann SR, Fox KAA, Rand AL. et al. Quantification of regional myocardial blood flow in vivo with H₂ ¹⁵O. Circulation 1984; 70 No. 4 724-33.
3 Bergmann SR, Herrero P, Markham J. et al. Noninvasive Quantitation of Myocardial Blood Flow in Human Subjects With Oxygen-15-Labeled Water and Positron Emission Tomography. J Am Coll Cardiol 1989; 14: 639-52.
4 Demer LL, Gould KL, Goldstein RA. Assessment of Coronary Artery Disease Severity by Positron Emission Tomography. Comparison With Quantitative Arteriography in 193 Patients. Circulation 1989; 79: 825-35.
5 Demer LL. Evaluation of Myocardial Blood Flow in Cardiac Disease. In: Cardiac Imaging. A Companion to Braunswald’s Heart Disease. Marcus ML, Schelbert HR, Skarton DJ, Wolf GL, Braunwald E. (eds). Philadelphia: WB Saunders; 1991: 1169-89.
6 Go RT, Marwick TH, MacIntyre WJ. et al. A Prospective Comparison of Rubidium-82 PET and Thallium-201 SPECT Myocardial Perfusion Imaging Utilizing a Single Dipyridamole Stress in the Diagnosis of Coronary Artery Disease. J Nucl Med 1990; 31: 1899-905.
7 Gould KL. Positron Emission Tomography and Interventional Cardiology. Am J Cardiol 1990; 66: 51F-58F.
8 Gould KL. Clinical Cardiac Positron Emission Tomography: State of the Art. Circulation. 1991 84. (supp I): I-22-I-36.
9 Gould KL. Positron Emission Tomography of the Heart. In: Coronary Artery Stenosis. Gould KL. (ed). New York: Elsevier; 1991: 137-10.
10 Herrero P, Markham J, Shelton ME. et al. Noninvasive Quantification of Regional Myocardial Perfusion With Rubidium-82 and Positron Emission Tomography. Exploration of a Mathematical Model. Circulation 1990; 82: 1377-86.
11 Herrero P, Markham J, Shelton ME. et al. Implementation and Evaluation of a Two-Compartment Model for Quantification of Myocardial Perfusion With Rubidium-82 and Positron Emission Tomography. Research 1992; 70: 496-507.
12 Huang SC, Williams BA, Krivokapich J. et al. Rabbit myocardial ⁸²Rb kinetics and a compartmental model for blood flow estimation. Am J Physiol 1989; 256 (Heart Cir Physiol 25): H1156-H1164.
13 Hutchins GD, Schwaiger M, Roscnspire KC. et al. Noninvasive Quantification of Regional Blood Flow in the Human Heart Using N-13 Ammonia and Dynamic Positron Emission Tomographic Imaging. J Am Coll Cardiol 1990; 15: 1032-42.
14 Iida H, Kanno I, Takahashi A. et al. Measurement of Absolute Myocardial Blood Flow With H₂O-⁻¹⁵ and Dynamic Positron-Emission Tomography. Strategy for Quantification in Relation to the Partial-Volume Effect. Circulation 1988; 78: 104-15.
15 Krivokapich J, Smith GT, Huang SC. et al. N₋₁ ³ Ammonia Myocardial Imaging at Rest and With Exercise in Normal Volunteers. Quantification of Absolute Myocardial Perfusion With Dynamic Positron Emission Tomography. Circulation 1989; 80: 1328-37.
16 MacIntyre WJ, Go RT, King JL. et al. Clinical Outcome of Cardiac Patients with Negative Thallium-201 SPECT and Positive Rubidium-82 PET Myocardial Perfusion Imaging. J Nucl Med 1993; 34: 400-4.
17 Mullani NA, Goldstein RA, Gould KL. et al. Myocardial Perfusion with Rubidium-82. I. Measurement of Extraction Fraction and Flow with External Detectors. J Nucl Med 1983; 24: 898-906.
18 Opherk D, Mall G, Zebe H. et al. Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation 1984; 69 No 1 1-7.
19 Rau G. Messung der Koronardurchblutung mit der Argon-Fremdgasmethode. Tierex-perimente und Untersuhungen am Patienten bei niedriger und hoher Durchblutung. Arch f Kreislauff 1969; 58: 322-98.
20 Sachs L. Statistische Methoden: Planung und Auswertung. Berlin: Springer-Verlag 7. Aufl; 1993
21 Schwaiger M, Muzik O. Assessment of Myocardial Perfusion by Positron Emission Tomography. Am J Cardiol 1991; 67: 350-430.
22 Selwyn AP, Allan RM, L’Abbatc A. et al. Relation Between Regional Myocardial Uptake of Rubidium-82 and Perfusion: Absolute Reduction of Cation Uptake in Ischemia. Am J Cardiol 1982; 50: 112-21.
23 Senda M, Nishizawa S, Yonekura Y. et al. Measurement of arterial time activity curves by monitoring continuously drawn arterial blood: errors and corrections. J Nucl Med 1986; 27: 1001.
24 Shea MJ, Wilson RA, deLandsheerc CM. et al. Use of Short- and Long-Lived Rubidium Tracers for the Study of Transient Ischemia. J Nucl Med 1987; 28: 989-97.
25 Stewart RE, Schwaiger M, Molina E. et al. Comparison of Rubidium-82 Positron Emission Tomography and Thallium-201 SPECT Imaging for Detection of Coronary Artery Disease. Am J Cardiol 1991; 67: 1303-10.
26 Strauer BE. Coronary Hemodynamics in Hypertensive Heart Diseases. Basic Concepts, Clinical Consequences, and Experimental Analysis of Regression of Hypertensive Microangiopathy. Am J Med 1988; 84 (suppl 3 A): 45-54.
27 Tauchert M, Kochsick K, Heiß HW. et al. Technik der Organdurchblutungsmcssung mit der Argon-Mcthodc. Z f Krcislauff 1971; 60: 871-80.
28 Weinberg IN, Huang SC, Hoffmann EJ. et al. Validation of PET-Acquricd Input Functions for Cardiac Studies. J Nucl Med 1988; 29: 241-7.
29 Wilson RA, Shea M, deLandsheere C. et al. Rubidium-82 Myocardial Uptake and Extraction After Transient Ischemia: PET Characteristics. J Comput Assist Tomogr 1987; 11: 60-66.