如何解讀心肌灌注掃描報告？-心臟血管專科

請問黃醫師協助超音波及心肌灌注結果建議，感恩謝謝？

台 北 醫 學 大 學 附 設 醫 院 REPORT OF NUCLEAR MEDICINE STRESS/REDISTRIBUTION MYOCARDIAL PERFUSION SCAN Chart No: 13531711 姓Date: 08/31/2022 CLINICAL HISTORY: 51-yr-old male (64kg) is a case of chest tightness recently - referred for detection of ischemic heart disease. TECHNIQUE: After intravenous administration of dipyridamole (Persantin) 0.56 mg/kg in 3-5 minutes, patient received I.V. injection of 8 mCi of Tc-99m MIBI SPECT. One hour later, imaging of the heart was performed using a gamma camera. After a period of approximately 3-4 hours, the patient was reinjection of 24 mCi of Tc-99m MIBI. Image was acquired in a similar fashion as well. Single photon emission tomograms were reconstructed in horizontal and vertical long axis, as well as short axis projections. Bull’ s eye analysis was performed on paired, registered (stress/redistribution) short axis images. Data of ECG-gated SPECT were analyzed and displayed. Data of ECG- gated SPECT were analyzed and displayed. SCINTIGRAPHIC FINDINGS: (1) Perfusion defects of the left ventricle (LV) are noted: * Mild-to-moderate reversible defect at inferolateral wall. * Decreased radioactivity at basal inferoseptal wall. (2) Lung uptake is normal. * Lung-to-heart ratio of stress: 0.22 * Lung-to-heart ratio of rest: 0.28 (3) Extent of perfusion defects by Bull’s eye analysis: * Stress → rest: LAD: 12%→ 0%, LCX: 34%→ 0%, RCA: 0%→ 0%. * Reversible defect: LAD 6%, LCX 29%, RCA 0%. * Fixed defect: LAD 6%, LCX 5%, RCA 0%. * Severity of perfusion defects: SSS of 2, SDS of 2. (4) ECG-gated SPECT results: * Stress/Rest LVEF: 65%/64%. * No obvious wall motion abnormality. IMPRESSION: Positive MPI study is summarized below: (1) Mild-to-moderate ischemia at inferolateral wall. (2) Ischemia or artifact at basal inferoseptal wall. (3) Stress/Rest LVEF: 65%/64%; No wall motion abnormality. (Remark) * MPI (myocardial perfusion image) focused on LV of heart. Report by： / 蔡雅茹杜卜勒氏超音波心臟圖Routine M - mode data 1.AO root 30.9 (20-37mm) 5.LVEDD 49.2 (35-53mm) 2.LA 34.1 (19-40mm) 6.LVESD 32.5 (20-35mm) 3.IVS 9.1 (7-10mm) 7.LVEF 62.6 (＞50%) 4.LVPW 9.9 (8-13mm) Routine 2D data 1.AO root (20-37mm) 5.LVEDD (35-53mm) 2.LA (19-40mm) 6.LVESD (20-35mm) 3.IVS (7-10mm) 7.LVEF 73.7 (＞50%) 4.LVPW (8-13mm) Color-mapped Doppler data 1.Ao Flow 121.0 (cm/s) 9.MV PG (mmHg) 2.Ao Area (cm2) 10.PA flow (cm/s) AV Area(2D) (cm2) 3.Ao PG Peak 5.8 (mmHg) 11.PA PG (mmHg) 4.Ao PG Mean (mmHg) 12.PV-acceleration time (cm/s) 5.MV E Flow 70.0 (cm/s) 13.TR Vmax 210.0 (cm/s) 6.MV A Flow 56.4 (cm/s) 14.TR PG 11.400 (mmHg) 0.108 (ms) 15.TR RVSP (mmHg) 7.MV deceleration time 8.MV Area (cm2) 16.E / E’(Lat) 9.87 MV Area(2D) (cm2) E / E’(Med) 4.21 Diagnosis: 1. Normal LV chamber size with preserved LV systolic function, EF56 % 2. Thickened AV with trivial AR 3. MVP with trivial MR 4. Normal pulmonary artery pressure with RVSP 23 mmHg with trivial TR, PR Suggesion: Color doppler Findings MS ( )Nil ( )trivial( )mild ( )moderate( )Mod-Severe( )severe MR ( )Nil ( )trivial( )mild ( )moderate( )Mod-Severe( )severe AS ( )Nil ( )trivial( )mild ( )moderate( )severe AR ( )Nil ( )trivial( )mild ( )moderate( )Mod-Severe( )severe TR ( )Nil ( )trivial( )mild ( )moderate( )Mod-Severe( )severe PS ( )Nil ( )trivial( )mild ( )moderate( )severe ( )Nil ( )trivial( )mild ( )moderate( )Mod-Severe( )severe PR