Sympathische Reinnervation nach Herztransplantation -Doppelnuklidstudie mit ¹²³J-MIBG und ²⁰¹Tl

Zusammenfassung

Zum Nachweis der sympathischen Reinnervation wurden 15 Patienten 2 bis 69 Monate nach Herztransplantation im Rahmen einer Doppelnuklidstudie mit ¹²³|-MIBG und ²⁰¹TI untersucht. Da MIBG eine sich dem Noradrenalin analog verhaltende Substanz ist, gestattet es Rückschlüsse auf die Integrität und Funktion des sympathischen Nervensystems. Zum Landmarking der Myokardregion diente ²⁰¹TI. Planare anteriore Aufnahmen wurden 15 min und 4 h p. i. von 220 MBq ¹²³|-MIBG und 37 MBq ²⁰¹TI angefertigt. Der kardiale MIBG-Uptake wurde aus dem Quotienten der kardialen und mediastinalen Aktivität errechnet. Acht Patienten zeigten 2 bis 34 Monate nach Transplantation keinen Hinweis auf Sympathikus-Reinnervation. Ein deutlicher anterobasaler MIBG-Uptake konnte bei 6 Langzeit-transplantierten mit einem Organalter von 37 bis 69 Monaten nachgewiesen werden. Ein Patient mit einem 59 Monate alten Herzen zeigte keinen MIBG-Uptake. Ein vermehrter MIBG-Uptake der antero-basalen Region war bei 40% der untersuchten Patienten mit einem mittleren Organalter von 51 Monaten als Zeichen partieller sympathischer Reinnervation nachweisbar.

Summary

Sympathetic reinnervation was evaluated in 15 patients 2-69 months after heart transplantation using a double-tracer technique with ¹²³|-MIBG and ²⁰¹TI. Since MIBG is accumulated in the same manner as norepinephrine it may serve as a tracer of the integrity and function of the sympathetic nervous system. ²⁰¹TI was used for landmarking. Planar anterior imaging was performed 15 min and 4 h after i.v. injection of 220 MBq ¹²³|-MIBG and 37 MBq ²⁰¹TI. Image quantitation was based on the ratio of myocardial to mediastinal MIBG-uptake. Cardiac regions of interest were defined according to the ²⁰¹TI uptake. There was no evidence of sympathetic reinnervation in 8 patients 2-34 months after transplantation. Increased MIBG-uptake could be observed in the anterior basal region in 6 long-term cardiac transplants (37-69 months). One patient with a 59-month-old transplanted heart did not reinnervate. Increased MIBG-uptake in the anterior basal region indicating partial sympathetic reinnervation could be shown in 40% of the investigated patients with an average organ age of 51 months.

Schlüsselwörter:

Neurotransmitterszintigraphie - Herztransplantation - sympathische Reinnervation

Key words

Neurotransmitter-scintigraphy - heart transplantation - sympathetic reinnervation

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