| Objective1 Through gated myocardial perfusion imaging, observe myocardial blood perfusion and cardiac function of patients in Duchenne muscular dystrophin (DMD), explore the variation of the cardiac muscle and cardiac function, reveal the development rule on the change of the myocardial cells in DMD, for providing the important scientific basis on researching deeply in DMD.2 Through using technology of noninvasive gated myocardial perfusion imaging, analysis intramyocardial radioactive distribution and different ventrivular wall damage of patients in DMD, judge the scope and extent of myocardial damaged, comparative analysis the myocardial perfusion and cardiac function in different age stages, evaluate diagnostic value of gating myocardial perfusion imaging in detecting myocardial damaged of DMD.3 Through the observation and analysis of myocardial damaged in DMD, make clear the myocardial characteristics in imageology, explore the heart damage mechanism, study the development laws of myocardial damaged throughout the process of the disease and provide necessary information for the early diagnosis of cardiac injury. Provide a reliable new way of finding myocardial damage in DMD so that the clinical doctors can promptly give patients the appropriate myocardial cell protection treatment, delay the myocardial damage, prolong the patients'life, and improve the quality of life of the patients.Methods1 99Tcm-MIBI gated myocardial perfusion imaging were performed on 39 cases in DMD group and 11 cases of the control group. Parameters of image acquisition and processing were taken corrective action according to the literature. Using the method of dividing left ventricle into seven segments, press lesions involving the room segmental wall points for mild, moderate, severe damage; using 20 segments and section 0 to 4 points, five points half quantitative method to evaluate intramyocardial radioactive distribution and damaged range.2 Based on the three dimension reconstruction, quantitative analysis were performed by application of gating myocardial software QGS, and separately calculated left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end systolic volume (ESV). Because the patients mostly were children, using end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) which standardized the EDV and ESV by the body surface area(BSA).3 35 positive cases of gating myocardial perfusion imaging, were divided into3 groups according to different age stages, comparative analysis the change of intramyocardial radioactive distribution and myocardial damaged scope; comparative analysis the changes of LVEF,EDV,ESV,EDVI,ESVI between the positive cases and the control group according to different age stages.Results1 Of the 39 DMD cases, 35 patients were positive which diagnosed by 99Tcm-MIBI gating myocardial perfusion imaging, and its rate was 89.7% (35/39). Press lesions involving the ventricular segmental wall (7sections) for: a single section abnormality was in 13 cases (mild 37.2 %), 2 sections abnormalities in 11 patients (moderate 31.4 %), 3 and more sections abnormalities, such lesions are scattered over in 11 patients (severe 31.4 %).2 Using half quantitative method of 20 segments and 5 points, in 700 segments of 35 positive patients, detected 290 abnormal sub-series segments, for radioactive distribution within the myocardium: 79 segments were mild decrease (1 point 27.2 %), 122 segments were moderate decrease (2 points 42.1 %), 70 segments were serious decrease (3 points 24.1 %), 19 segments without radioactive distribution (4 points 6.6 %). 3 The distribution of abnormal 290 segments according to press lesions involving ventricular parts was: 43 segments located on apical; 41 segments, anterior wall; 36 segments, anterior of lateral wall; 36 segments, inferior of lateral wall; 48 segments, inferior wall; 50 segments, inferior of septum wall; 36 segments, anterior of septum wall.4 The distribution of abnormal 290 segments in different age groups was: 35 patients which gating myocardial perfusion imaging were positive, were divided into 3 groups by different age stages, respectively to≤5 years old group for 103 segments damaged;≤9 years old group for 90 segments damaged;≤13 years old group for 97 segments damaged.5 In 35 cases of myocardial perfusion imaging positive, LVEF was 56.2±9.1%, EDV was 57.6±13.8ml, ESV was 21.3±7.5ml, EDVI was 60.8±11.2ml/m2, ESVI was 21.8±7.1ml/m2. 3 patients with LVEF decreased to 42.1±6.4%, EDV was 69.2±11.4ml,ESV was 42.9±5.7ml;EDVI was 71.1±10.2ml/m2,ESVI was 43.2±7.1ml/m2;left ventricular were showed for generally poor coordination.Conclusion1 Patients in DMD can incorporate cardiomyopathy and 99Tcm-MIBI gated myocardial perfusion imaging can show the change of intramyocardial radioactive distribution and damaged degree and range; the application of gated myocardial quantitative software QGS can provide cardiac function parameters, such as LVEF ESV EDV, which can provide abundant information in evaluating myocardial damaged in DMD.2 Radioactive distribution reduce can emerge earlier in many myocardial segments in DMD patients, while cardiac dysfunction appears later. Gating myocardial perfusion imaging characteristics in multiple small lesions, majority is multi-walls myocardial involvement, myocardial performs erythema characteristics; along with the growth of the age and the progress of the disease, the range and degree of myocardial damaged will be further developed. DMD myocardial damaged most performance for subclinical damage, cardiac function anomalies are rare, but along with the growth of the age, the trend will be aggravated.3 Myocardial injury of DMD can be observe objectively by 99Tcm-MIBI gated myocardial perfusion imaging. 99Tcm-MIBI gated myocardial perfusion imaging can be used as a conventional, noninvasive method and have higher auxiliary diagnosis value of myocardial injury in early assessment and long-term follow-up.
|
PDF Full Text Request