摘要
目的对比核素心肌灌注/代谢显像[以下简称^(18)F-氟脱氧葡萄糖(FDG)PET]与心脏磁共振成像(CMR)在缺血性心脏病患者心肌活力评价中的价值。方法回顾性分析2016年3月至2019年12月于中国医学科学院阜外医院同期(一个月内)接受^(18)F-FDG PET与CMR评价心肌活力的缺血性心脏病合并心功能不全的患者285例,其中男性260例、女性25例,年龄(57.8±10.0)岁。按照17节段法分析^(18)F-FDG PET与CMR 2种方法鉴别各心肌节段存活心肌与梗死心肌结果的一致性和差异。采用Spearman相关系数和Kendall′s tau-b相关系数分析2种方法之间鉴别心肌活力类型的相关性。采用Bland-Altman法分析比较2种方法检测梗死心肌的一致性。结果285例患者总共4845个心肌节段,共有3376个(69.7%)^(18)F-FDG PET显示室壁运动异常的心肌节段被纳入分析。^(18)F-FDG PET与CMR检测的梗死心肌总含量分别为17.6%±13.0%和19.2%±13.4%,二者之间存在显著的相关性(r=0.67,P<0.001)。与CMR相比,^(18)F-FDG PET对于梗死心肌总含量的检测存在一定程度的低估(梗死心肌总含量差值的95%CI为-12.7%~27.8%,平均差值为7.5%)。在CMR检测为透壁梗死的697个运动异常节段中,^(18)F-FDG PET检测绝大多数(90.4%,630/697)节段可见透壁或非透壁梗死,二者显示出较高的一致性。而在CMR检测为非透壁梗死的1371个节段中,却有多达686个(50.0%)节段^(18)F-FDG PET未检测到梗死改变。在个体水平,CMR检测的每例患者的梗死心肌总含量与^(18)F-FDG PET检测的冬眠心肌总含量之间无显著的相关性(r=-0.09,P=0.12)。在节段水平,在CMR检测为非透壁梗死的1371个节段中,^(18)F-FDG PET检测838个(61.1%)节段有冬眠心肌;而在CMR检测为透壁梗死的697个节段中,^(18)F-FDG PET检测286个(41.0%)节段有冬眠心肌。CMR检测为非透壁梗死的节段比透壁梗死的节段含有更多的冬眠心肌(61.1%对41.0%,χ^(2)=66.207,P<0.001)。结论^(18)F-FDG PET与C
Objective To compare the capability of radionuclide myocardial perfusion/metabolic imaging(hereinafter referred to as ^(18)F-FDG PET)and cardiac magnetic resonance(CMR)in the assessment of myocardial viability among patients with ischemic heart failure.Methods A total of 285 consecutive patients with ischemic heart failure combined with cardiac dysfunction who underwent ^(18)F-FDG PET and CMR imaging simultaneously(within a month)at Fuwai Hospital,Chinese Academy of Medical Sciences from March 2016 to December 2019 were included in the retrospective analysis.The patients comprised 260 males and 25 females,aged(57.8±10.0)years.The 17-segment method was used to compare the agreement and differences of ^(18)F-FDG PET and CMR in the identification of viable myocardium and infarcted myocardium in each myocardial segment.Spearman correlation coefficient and Kendall′s tau-b correlation coefficient were used to analyze the correlation between the two methods in the identification of different myocardial viabilities.The Bland-Altman method was used to evaluate the diagnostic agreement between the two methods in assessing infarcted myocardium.Results Of the 285 patients with a total of 4845 myocardial segments,3376(69.7%)myocardial segments with wall motion abnormality on ^(18)F-FDG PET were included in the analysis.The total content of infarcted myocardium measured through ^(18)F-FDG PET and CMR was 17.6%±13.0%and 19.2%±13.4%,respectively,and a significant correlation existed between them(r=0.67,P<0.001).By contrast,^(18)F-FDG PET may underestimate the content of infarcted myocardium compared with CMR(The 95%CI of the total difference in infarcted myocardium content was-12.7%–27.8%,and the mean difference was 7.5%).Among the 697 segments with motion abnormality detected through CMR as transmural infarctions,most(90.4%,630/697)showed transmural or non-transmural infarctions detected through ^(18)F-FDG PET,showing a high agreement between the two methods.Among the 1371 segments detected as non-transmural infarctions
作者
宋书扬
韩旭
汪蕾
闫朝武
方纬
Song Shuyang;Han Xu;Wang Lei;Yan Chaowu;Fang Wei(Peking Union Medical College,National Center for Cardiovascular Diseases,Department of Nuclear Medicine,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China;Peking Union Medical College,National Center for Cardiovascular Diseases,Department of Structural Heart Disease,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)
出处
《国际放射医学核医学杂志》
2024年第1期38-45,共8页
International Journal of Radiation Medicine and Nuclear Medicine
关键词
心肌缺血
心肌梗死
心肌顿抑
心肌灌注显像
正电子发射断层显像术
心肌代谢显像
磁共振成像
Myocardial ischemia
Myocardial infarction
Myocardial stunning
Myocardial perfusion imaging
Positron-emission tomography
Myocardial metabolism imaging
Magnetic resonance imaging
