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DOI: 10.1055/s-0038-1629718
Vergleich von relativer 18FDG-Aufnahme mit metabolischer Rate (MRGlukose) im Myokard bei KHK, klassifiziert mit 99mTc-MIBI
Comparison of Relative 18FDG Uptake to Metabolie Rate (MRGlucose) in the Myocardium in CAD, Classified by 99mTc MIBI[*]Publikationsverlauf
Eingegangen:
01. August 1995
in revidierter Form:
25. August 1995
Publikationsdatum:
05. Februar 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/199506/lookinside/thumbnails/10-1055-s-0038-1629718_de-1.jpg)
Zusammenfassung
Ziel: Sind a) die typischen Perfusions-/Stoffwechsel-Befundmuster (Match, Mismatch) aus dem Vergleich 99mTc-MIBI-/18FDG-Speicherung (normiert auf das Perfusionsmaximum) auch für 99mTc-MIBI-/regionale MRGlukose (Glu; Auswertung nach Patlak) zu finden und ist b) rMGIu im Perfusionsmaximum für alle Schweregrade der KHK im Richtwertebereich? Methoden: Bei 55 Patienten mit KHK wurden die relative myokardiale Speicherung von 99mTc-MIBI (in Ruhe; SPECT) und von 18FDG (nach Glukoseladung, PET) vergleichend zu rMRGIu (in fxmol/100 g/min) in je 13 Segmenten des linken Ventrikels (insgesamt 715 Segmente) bestimmt. Ergebnisse: Die rMRGIu zeigte Streubreiten von bis zu 51 %. Sie nahm in der Reihenfolge normal (52,7 ± 27,3 fxmol/100 g/min), mismatch (45,3 ± 17,3), intermediär (35,2 ± 12,4) nach match (»avital«, 26,7 ± 13,3) signifikant (p <0,01) ab. In 26% der Perfusionsmaxima war MIRGIu <40 fxmol/ 100 g/min, darunter nur bei fünf Dreigefäßerkrankungen (von 28) <30 fxmol. Die Serumglukosewerte zeigten bei drei dieser fünf Patienten eine ungenügende Antwort auf die orale Glukosebelastung. Schlußfolgerung: rMIRGIu erbrachte bei KHK die gleichen Fluß/Stoffwechsel-Befundmuster wie die relative FDG-Speicherung. Der größere Aufwand für die Berechnung von rMRGIu ergab keinen diagnostischen Vorteil. Das Perfusionsmaximum (100% MIBI) als Bezugswert für FDG (= 100% FDG) war auch bei euglykämisch eingestellten Patienten mit Dreigefäßerkrankungen verläßlich.
Summary
Aim: Are i) typical patterns of perfusion/metabolism (match, mismatch), gained from relative 99mTc-MIBI vs relative 18FDG uptake (normalized to the perfusion maximum) obtainable also vs absolute MRGIu and is ii) rMRGIu in the segment of maximum perfusion (MIBI = 100%) within the normal range for all degrees of coronary artery disease (CAD)? Methods: In 55 non-diabetic patients with CAD, relative myocardial perfusion (99mTc MIBI SPECT at rest) and relative 18FDG uptake (PET after glucose load) were used to separate for various flow/metabolism constellations. In addition, regional glucose metabolic rate (rMRGIu in ixmol/ 100 g/min; dynamic-graphic analysis from Gambhir/Patlak) was determined in 13 segments of the left ventricle each (i. e., in a total of 715 segments). Results: rMRGIu revealed wide standard deviations (up to 51%). It decreased from normal (52.7 ± 27.3 (xmol/100 g/min), mismatch (45.3 ± 17.3) and intermediate (35.2 ± 12.4) to match (»non viable«; 26.7 ± 13.3) significantly (p <0.01). In 26% of the perfusion maxima, MRGIu was <40 (xmol/100 g/min. Out of these, only in five patients (of 28) with 3-vessel disease, it was even smaller (<30 (xmol). In three out of the latter, glucose blood levels were below euglycemia. Conclusion: rMRGIu in CAD revealed an identical perfusion/metabolism pattern as relative 18FDG uptake. Thus, the higher efforts employed to compute rMRGIu do not yield diagnostic advantage. The segmental perfusion maximum, used for normalization of relative 18FDG uptake (100% MIBI uptake = 100% FDG uptake) was reliable in euglycemic patients even with 3-vessel disease.
* Diese Arbeit enthält Teile der Inauguraldissertation von Frau cand. med. Y. Foroutan.
* Medizinischen Klinik I der RWTH, Klinikum Aachen, Deutschland
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