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Kokyu to Junkan Volume 36, Issue 6 （June 1988）

呼吸と循環 36巻6号（1988年6月発行）

Japanese English

研究

ポジトロンCTによる拡張型心筋症と冠動脈疾患の対比 Evaluation of dilated cardiomyopathy and coronary artery disease using positron CT (PCT) 不藤哲郎 ¹ , 神原啓文 ¹ , 橋本哲男 ¹ , 林正隆 ¹ , 河合忠一 ¹ , 千田道雄 ² , 米倉義晴 ² Tetsuro Fudo ¹ , Hirofumi Kambara ¹ , Tetsuo Hashimoto ¹ , Masataka Hayashi ¹ , Chuichi Kawai ¹ , Michio Senda ² , Yoshiharu Yonekura ² ¹京都大学第3内科 ²京都大学核医学科 ¹The 3rd Division of Internal Medicine, Kyoto University ²Nuclear Medicine, Kyoto University pp.649-653

発行日 1988年6月15日 Published Date 1988/6/15

DOI https://doi.org/10.11477/mf.1404205274

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Abstract 文献概要
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　拡張型心筋症dilated cardiomyopathy （DCM）の病態生理に関しては従来から左心カテーテル法^1,2），心エコー図法^3,4），核医学的検査法^5,6），生化学的^7），病理学的^8〜10），免疫学的研究^11）などさまざまな検討がなされている。しかしながらその本態にはなお不明の点が多く残されている。ことに心筋代謝に関しては今後の解明を待つ領域である。今回我々はpositron emission CT（PCT）をDCM患者と冠動脈疾患（CAD）患者に対し施行した。PCTは従来の核医学的検査法に比べ解像力にすぐれ，血流のみならず心筋代謝をも評価しうる利点があり^12），興味ある所見を得たので報告する。

Positron CT (PCT) has higher sensitivity and better spatial resolution than single photon emission CT (SPECT) and makes quantitative analysis possible. It can also use physiological tracers and can visualize not only blood flow distribution of the heart but also myocardial metabolism, because PCT can use constituent elements of living bodies such as C, H and O.

In this study, PCT was performed using N-13 labelled ammonia (NH₃) as a marker of myocardial blood flow and F-18 labelled fluoro-deoxy-glucose (FDG) as a marker of glucose metabolism in a patient with dilated cardiomyopathy and one with severe coronary artery disease. Initial distribution of NH₃ is considered to reflect myocardial blood flow. FDG is incorporated into myocytes and phosphory-lated through same mechanism as glucose, but it cannot be metabolized any more and represents myocardial glucose utilization.

Case 1: a case of DCM, 57-year-old woman.Twelve-lead electrocardiogram showed intraventri-cular conduction delay. Left ventriculogram demon-strated diffuse hypokinesis (ejection fraction=25%). NH₃ and FDG PCT showed relatively even distri-bution. However, in the lateral wall increased uptake of both ammonia and FDG was observed.

Case 2: a case severe coronary artery disease, 42-year-old man. Intraventricular conduction delay and diffuse hypokinesis (ejection fraction=14%)were observed Coronary angiogram demonstrated triple vessel involvement. Decreased uptake of NHs was observed in the area except for the inter-ventricular septum. On the contrary, increased uptake of FDG was observed in the hypoperfused region, suggesting the existence of viable myocar-dium which was dependent on the anaerobic meta-bolism of glucose.