ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2013-3-111-116ssmu-346Research ArticleИННОВАЦИОННЫЕ МЕДИЦИНСКИЕ ТЕХНОЛОГИИINNOVATIVE MEDICAL TECHNOLOGIESСЦИНТИГРАФИЧЕСКОЕ ОПРЕДЕЛЕНИЕ ВЕЛИЧИНЫ МИОКАРДИАЛЬНОГО КРОВОТОКАRADIONUCLIDE QUANTITATIVE IN ASSESSMENT OF MYOCARDIAL BLOOD FLOWКривоноговН. Г.KrivonogovN. G.minin@cardio.tsu.ruМининС. М.MininS. M.

Minin Stanislav M.

minin@cardio.tsu.ruКрыловА. Л.KrylovA. L.

Krilov Aleksandr Yu.

minin@cardio.tsu.ruЛишмановЮ. Б.LishmanovYu. B.

Лишманов Юрий Борисович –  доктор медицинских наук, профессор, член-корреспондент РАМН

minin@cardio.tsu.ruНаучно-исследовательский институт кардиологии Сибирского отделения РАМН, ТомскРоссияInstitute of Cardiology of SB RAMS, TomskRussian Federation201328062013123111116Copyright © Кривоногов Н.Г., Минин С.М., Крылов А.Л., Лишманов Ю.Б., 20132013Кривоногов Н.Г., Минин С.М., Крылов А.Л., Лишманов Ю.Б.Krivonogov N.G., Minin S.M., Krylov A.L., Lishmanov Y.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/346

Цель исследования – предложить и апробировать сцинтиграфическую методику количественной оценки миокардиального кровотока с использованием отечественного радиофармпрепарата 99mТстехнетрила.В исследование включены 12 больных (мужчины в возрасте (58,8 ± 4,8) года) с диагнозом «ишемическая болезнь сердца, стенокардия напряжения I–III функционального класса». Для количественного определения миокардиального кровотока всем пациентам были проведены сравнительные сцинтиграфические исследования с 99mТс-технетрилом (99mТс-ТНЛ) и с интравентрикулярно введенными 99mТс-макроагрегатами альбумина человеческой сыворотки крови (99mТс-МАА). Полученные результаты показали, что коронарная фракция аккумуляции 99mТс-ТНЛ и количественные показатели миокардиального кровотока, вычисленные по данным сцинтиграфии с использованием этого радиофармпрепарата, статистически значимо коррелируют со значениями коронарного кровотока, определенными при помощи сканирования с 99mТс-МАА.

The aim of this study were to develop a radionuclide method for quantitative estimation of the myocardial blood flow (MBF). Twelve patients with suspected coronary artery disease underwent both Tc-99mmethoxyisobutylisonitrile (MIBI) imaging and coronary arterial injection of Tc-99m-radioalbumin macroaggregates (MAA). The myocardial uptake and MBF obtained using radionuclide angiocardiography and relative distributions of Tc-99m-MIBI were compared with the obtained using whole body with MAA as the gold standard. The myocardial uptake and MBF measured by MIBI imaging showed a good linear correlation with the myocardial uptake and MBF measured by MAA. These results indicate that MBF may be estimated by Tc-99m-MIBI imaging and can be used for the early detection and estimation of the functional severity of coronary lesions.

ишемическая болезнь сердцасцинтиграфия миокардамиокардиальный кровоток99mTc-технетрил99mТс-макроагрегаты альбуминаcoronary artery diseaseradionuclide imagingmyocardial blood flowTc-99-MIBITc-99m-radioalbumin macroaggregatesReferencesКомитет экспертов Всероссийского научного общества кардиологов. Диагностика и лечение стабильной стенокардии. Российские рекомендации / под ред. Е.И. Чазова // Кардиоваск. тер. и проф. Прил. М., 2004.Committee of Experts Russian Society of Cardiology. Diagnosis and treatment of stable angina. Russian recommendations. Ed. E.I. Chazov. Cardiovask. ter. and prof. Appendix. Moscow, 2004, pp. 3–19 (in Russian).Лишманов Ю.Б., Ефимова И.Ю., Чернов В.И. и др. Сцинтиграфия как инструмент диагностики, прогнозирования и мониторинга лечения болезней сердца // Сиб. мед. журн. 2007. Т. 3. С. 74–77.Lishmanov Yu.B., Efimova I.Y., Chernov V.I. et al. The Siberian Medical Journal, 2007, vol. 3, pp. 74–77 (in Russian).Лишманов Ю.Б., Чернов В.И. Радионуклидная диагностика для практических врачей. Томск: STT, 2004. 394 с.Lishmanov Yu.B., Chernov V.I. Nuclear medicine for practicing physicians. Tomsk, STT Publ., 2004. 394 p. (in Russian).Минин С.М. Сравнительная оценка ОЭКТ и планарной ЭКГ-синхронизированной сцинтиграфии сердца с 99мТстетрофосмином в диагностике жизнеспособного миокарда у больных хронической ИБС // Сиб. мед. журн. 2005. Т. 20, № 2. С. 144.Minin S.M. The Siberian Medical Journal, 2005, vol. 20, no. 2, pp. 144.Рыжкова Д.В., Нифонтов Е.М., Тютин Л.А. Позитронная эмиссионная томография как метод неинвазивной оценки миокардиального кровотока и коронарного резерва у пациентов с сердечно-сосудистой патологией // Артериальная гипертензия. 2006. Т. 2, № 3. С. 200–211.Ryzhkova D.V., Nifontov E.M., Tyutin L.A. Hypertension, 2006, vol. 12, no. 3, pp. 200–211.Чорголиани Т.Н. Количественное определение коронарного кровотока с помощью меченых микросфер альбумина: дис. … кандидат медицинских наук. М., 1987. 210 с.Chorgoliani T.N. Quantification of coronary blood flow with labeled albumin microspheres: author. dis. cand. med. sci. Moscow, 1987. 24 p.Barbato E., De Bruyne B., MacCarthy P. et al. Functional assessment of coronary atherosclerosis in the catheterization laboratory: the key role of fractional flow reserve // Ital. Heart. J. 2005. № 6. P. 549–556.Barbato E., De Bruyne B., MacCarthy P. et al. Functional assessment of coronary atherosclerosis in the catheterization laboratory: the key role of fractional flow reserve. Ital. Heart. J., 2005, no. 6, pp. 549–556.Clark A.N., Beller G.A. The present role of nuclear cardiology in clinical practice // Q. J. Nucl. Med. Mol. Imaging. 2005. № 49. P. 43–58.Clark A.N., Beller G.A. The present role of nuclear cardiology in clinical practice // Q. J. Nucl. Med. Mol. Imaging, 2005, no. 49, pp. 43–58.Cuocolo A., Petretta M., Soricelli A. Measurement of coronary flow reserve by noninvasive cardiac imaging // Eur. J. Nucl. Med. Mol. Imaging. 2010. V. 37. С. 1198–1202.Cuocolo A., Petretta M., Soricelli A. Measurement of coronary flow reserve by noninvasive cardiac imaging. Eur. J. Nucl. Med. Mol. Imaging, 2010, vol. 37, pp. 1198–1202.Di Carli M., Czenin J., Hoh C.K. et al. Relation among stenosis severity, myocardial blood flow, and flow reserve in patients with coronary artery disease // Circulation. 1995. V. 91. P. 1944–1951.Di Carli M., Czenin J., Hoh C.K. et al. Relation among stenosis severity, myocardial blood flow, and flow reserve in patients with coronary artery disease. Circulation, 1995, vol. 91, pp. 1944–1951.Feldman R.L., Nichols W.W., Pepine C.J. et al. Hemodynamic significance of the length of a coronary arterial narrowings // Am. J. Cardiol. 1978. V. 41. P. 865–871.Feldman R.L., Nichols W.W., Pepine C.J. et al. Hemodynamic significance of the length of a coronary arterial narrowings. Am. J. Cardiol., 1978, vol. 41, pp. 865–871.Fischer J.J., Samady H., Mc Pherson J.A. et al. Comparison between visual assessment and quantitative angiography versus fractional flow reserve for native coronary narrowings of moderate severity // Am. J. Cardiol. 2002. V. 90. P. 205–210.Fischer J.J., Samady H., Mc Pherson J.A. et al. Comparison between visual assessment and quantitative angiography versus fractional flow reserve for native coronary narrowings of moderate severity. Am. J. Cardiol., 2002, vol. 90, pp. 205–210.Gengel F.M., Higuchi T., Javadi M.S., Lautamäki R. Cardiac Positron Emission Tomography // J. Am. Coll. Cardiol. 2009. № 54. P. 1–15.Gengel F.M., Higuchi T., Javadi M.S., Lautamäki R. Cardiac Positron Emission Tomography. J. Am. Coll. Cardiol., 2009, no. 54, pp. 1–15.Gould K.L., Lipscomb K., Hamilton G.V. et al. Physiologic basis for assessing critical coronary stenosis: instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve // Am. J. Cardiol. 1974. V. 33. P. 87–94.Gould K.L., Lipscomb K., Hamilton G.V. et al. Physiologic basis for assessing critical coronary stenosis: instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am. J. Cardiol., 1974, 33, pp. 87–94.Gould K.L. Quantification of coronary artery stenosis in vivo // Circ. Res. 1985. 57. P. 341–353.Gould K.L. Quantification of coronary artery stenosis in vivo. Circ. Res., 1985, 57, pp. 341–353.Heller L.I., Gates C., Popma J. et al. Intracoronary Doppler assessment of moderate coronary artery disease: comparison with 201T1 imaging and coronary angiography. FACTS study group // Circulation. 1997. V. 96. P. 484–490.Heller L.I., Gates C., Popma J. et al. Intracoronary Doppler assessment of moderate coronary artery disease: comparison with 201T1 imaging and coronary angiography. FACTS study group. Circulation, 1997, 96, pp. 484–490.Hutchins G.D., Schwaiger M., Rosenspire K.C. 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. V. 15. P. 1032–1042.Hutchins G.D., Schwaiger M., Rosenspire K.C. 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, pp. 1032–1042.Marini C., Bezante G., Gandolfo P. et al. Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes // Eur. J. Nucl. Med. Mol. Imaging. 2010. V. 37. P. 357–367.Marini C., Bezante G., Gandolfo P. et al. Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes. Eur. J. Nucl. Med. Mol. Imaging, 2010, 37, pp. 357–367.Okayama H., Sumimoto Т., Hiasa G. et al. Assessment of intermediate stenosis in the left anterior descending coronary artery with contrast-enhanced transthoracic Doppler echocardiography // Coron. Artery. Dis. 2003. № 14. Р. 247–254.Okayama H., Sumimoto Т., Hiasa G. et al. Assessment of intermediate stenosis in the left anterior descending coronary artery with contrast-enhanced transthoracic Doppler echocardiography. Coron. Artery. Dis., 2003, 14, pp. 247–254.Sapirstein L.A. Regional blood flow by fractional distribution of indicators // Am. J. Physiol. 1958. № 193. Р. 161.Sapirstein L.A. Regional blood flow by fractional distribution of indicators, Am. J. Physiol., 1958, 193, p. 161.Storto G., Cirillo P., Vicario M.L. et al. Estimation of coronary flow reserve by Tc-99m sestamibi imaging in patients with coronary artery disease: comparison with the results of intracoronary Doppler technique // J. Nucl. Cardiol. 2004. V. 11 (6). P. 682–688.Storto G., Cirillo P., Vicario M.L. et al. Estimation of coronary flow reserve by Tc-99m sestamibi imaging in patients with coronary artery disease: comparison with the results of intracoronary Doppler technique. J. Nucl. Cardiol., 2004, 11 (6), pp. 682–688.Taki J., Fujino S., Nakajima K. et al. (99m)Tc-sestamibi retention characteristics during pharmacologic hyperemia in human myocardium: comparison with coronary flow reserve measured by Doppler flowire // J. Nucl. Med. 2001. V. 42. P. 1457–1463.Taki J., Fujino S., Nakajima K. et al. (99m)Tc-sestamibi retention characteristics during pharmacologic hyperemia in human myocardium: comparison with coronary flow reserve measured by Doppler flowire. J. Nucl. Med., 2001, 42, pp. 1457–1463.Tsukamoto T., Ito Y., Noriyasu K. et al. Quantitative Assessment of Regional Myocardial Flow Reserve Using Tc-99m-Sestamibi Imaging Comparison With Results of O-15 Water PET // Circulation J. 2005. V. 69. P. 188–193.Tsukamoto T., Ito Y., Noriyasu K. et al. Quantitative Assessment of Regional Myocardial Flow Reserve Using Tc99m-Sestamibi Imaging Comparison With Results of O-15 Water PET. Circulation J., 2005, 9, pp. 188–193.

The authors declare that there are no conflicts of interest present.