臺灣博碩士論文加值系統

核醫鉈-201心肌灌注造影提供心肌細胞存活度的臨床應用，當心臟冠狀動脈狹窄的情形發生時，透過壓力相與休息相灌注血流可獲得心肌缺血或壞死的資訊。隨著影像技術的發展，在1980年後期開始將心電圖納入核醫心肌灌注造影，即心電圖(ECG)門控式單光子電腦斷層掃描(GSPECT)。它的主要優點是在不增加成本的情況下，透過心電圖門控 (ECG-gated) 技術同時獲得心肌灌注資訊和左心室功能訊息。本研究探討左心室射出分率(left ventricular ejection fraction, LVEF)、全灌流不足比例(total perfusion deficit, TPD) 、總壓力相積分(SSS)、左心室腔室容積(volume)之關聯性，依心肌灌注掃描影像的缺損部位推知冠狀動脈的狹窄分支，並依量化軟體得知左心室功能資訊、缺血嚴重程度、左心室腔室容積，以分析冠狀動脈疾病嚴重程度與左心室功能之相關性。結果顯示壓力相射出分率(EF_stress)與壓力相全灌流不足比例(TPD_stress)中度負相關(皮爾森相關係數r = -.437**)，壓力相射出分率(EF_stress)與壓力相左心室腔室容積(volume_stress)高度負相關(皮爾森相關係數r = -.803**)。壓力相全灌流不足比例(TPD_stress)與總壓力相積分(SSS)高度正相關(皮爾森相關係數r = .972**)，壓力相全灌流不足比例(TPD_stress)與左心室腔室容積(volume_stress)中度正相關(皮爾森相關係數r = .486**)。本研究結論為利用壓力相全灌流不足比例越高，其冠狀動脈影響較大且較嚴重，並可作為判斷心肌缺損的重要指標。

Thallium-201 scan provides myocardial perfusion imaging and evaluates myocardial cell viability. From stress phase and rest phase of 201Tl scan, we can easily exam whether myocardial tissue is ischemia or necrosis when the coronary stenosis happens. Electrocardiographically (ECG) gated myocardial perfusion single photon emission computed tomography (GSSPECT) was developed in the last 1980s. Gated SPECT studies allow simultaneous assessment of perfusion and function in a single-injection, single-acquistion sequence. This study was to analyze the relationships between left ventricular ejection fraction (LVEF), total perfusion deficit area ratio (TPD), summed stress score (SSS) and left ventricular cavity. The stress phase of ejection fraction and total perfusion deficit area ratio shown a moderate negative correlation (Pearson's correlation coefficient r = -.437**), the stress phase of ejection fraction and left ventricular cavity shown high negative correlation (Pearson's correlation coefficient r = -.803**). The stress phase of total perfusion deficit area ratio and summed stress score shown high positive correlation (Pearson's correlation coefficient r = .972**). Furthermore, the stress phase of total perfusion deficit area ratio and left ventricular cavity shown moderate positive correlation (Pearson's correlation coefficient r = .486**). The study briefly concluded that the high stress phase of total perfusion deficit area ratio will significantly reveal left coronary artery stenosis, and can serve as an important indicator to judge cardiac defect.

目 錄

口試委員審定書 I
誌謝 II
中文摘要 III
英文摘要 IV
目錄 V
圖目錄 VII
表目錄 VIII

第一章 緒論 1
1.1 前言 1
1.2 研究背景 1
1.3 研究目的 3

第二章 理論探討與文獻回顧 4
2.1 心臟生理學 4
2.2 冠狀動脈疾病 5
2.3 冠狀動脈疾病分期 6
2.4 冠狀動脈疾病診斷 6
2.5 心肌灌注單光子電腦斷層掃描 8
2.6 門控式心肌灌注單光子電腦斷層掃描 9
2.7 心輸出量與其機制 10
2.8 臨床應用 11

第三章 材料與方法 12
3.1 儀器設備 12
3.2 受檢者挑選 14
3.3 進行研究之流程與方法 14
3.4 統計方式 20

第四章 結果 21
4.1受檢者之屬性分布 21
4.2 參數分析結果 23
第五章 討論 34
參考文獻 38
附錄一同意臨床試驗/研究證明書 41
 
圖 目 錄

圖2-1 冠狀動脈分布圖 4
圖2-2 門控式的心肌灌注單光子電腦斷層掃描原理 10
圖3-1 組合式監視器 13
圖3-2 自動注射器 14
圖3-3 心電圖觸發監視器 14
圖3-4 雙頭加馬攝影機 14
圖3-5 門控式心肌灌注單光子電腦斷層掃描造影流程圖 15
圖3-6 左心室短軸、水平長軸及垂直長軸影像 16
圖3-7 QPS定量分析結果 16
圖3-8 QGS定量分析結果 18
圖3-9 左心室時間/體積曲線及充盈曲線 19

表 目 錄

表3-1 參數總表 20
表4-1 受檢者之屬性分布 23
表4-2 灌注資訊變項與功能資訊變項的相關性 25
表4-3 影響左心室容積重要因子逐步回歸摘要表 26
表4-4 不同缺血嚴重程度之左心室收縮及舒張功能參數的差異性檢定 27
表4-5 TPD分組與缺損區對應之冠狀動脈交叉表 29
表4-6 對注射dipyridamole不同的心跳反應分組與灌注缺損相關參數及功能參數的差異性檢定 30
表4-7 HR分組與缺損區對應之冠狀動脈交叉表 32
表4-8 不同壓力相與休息相的左心室射出分率差異分組與灌注缺損相關參數及功能參數的差異性檢定 33
表4-9 ΔEF分組與缺損區對應之冠狀動脈交叉表 35

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