门控SPECT及门控PET心肌显像评价左心室室壁瘤患者左心室功能的临床价值  

Comparison of gated SPECT with gated PET for evaluation of left ventricular function in patients with left ventricular aneurysm

作　　者：田丛娜[1] 科雨彤 魏红星[1] 王道宇[1] 田月琴[1] 陆敏杰[2] 边艳珠[4] 王跃涛[5] 赵世华[2] 张健[3] 张晓丽[1] 刘秀杰[1] 

机构地区：[1]北京协和医学院、中国医学科学院阜外心血管病医院核医学科,100037 [2]北京协和医学院、中国医学科学院阜外心血管病医院放射科,100037 [3]北京协和医学院、中国医学科学院阜外心血管病医院心内科,100037 [4]河北省人民医院核医学科 [5]苏州大学附属第三医院核医学科

出　　处：《中华核医学与分子影像杂志》2015年第5期364-367,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：基金项目：国家自然科学基金（8107177）

摘　　要：目的以MRI为“金标准”，比较门控99^Tc^m-MIBISPECT心肌灌注显像（G-SPECT）和门控18^F-FDGPET心肌代谢显像（G-PET）测定左心室室壁瘤（LVA）患者左心室功能及筛选左心室功能衰竭患者的准确性。方法选择2009年9月至2012年2月间行G-SPECT和G-PET、并经MRI确诊的LVA患者[96例，其中男88例，女8例，平均年龄（57±10）岁]进行回顾性分析。G-SPECT和G-PET均采用定量门控心肌断层显像（QGS）软件获得LVEF。非门控图像的心肌血流灌注评分采用17节段5分法进行半定量分析，4分代表无放射性分布，0分代表放射性分布正常。MRI图像采用Simpson法计算LVEF。采用SPSS17．0软件对数据行配对t检验、Pearson相关分析和Bland-Altman一致性检验。结果（1）根据心肌灌注缺损的节段数将患者分组发现，对于小范围心肌灌注缺损的患者（缺损0～2个节段，18例），G-PET、G-SPECT测定的LVEF与MRI测定值均相关（r=0．91和0．87，均P〈0．01），G-PET明显高估LVEF[（37±13）％与（34±10）％；t=2．850，P〈0．05]；对于大范围心肌灌注缺损的患者（缺损≥5个节段，48例），2种方法测定的LVEF与MRI测定值均相关（r=0．75和0．68，均P〈0．01），G-SPECT明显低估LVEF[（26＋-8）％与（30＋10）％；t=-3．992，P〈0．01]。（2）以MRI测定的LVEF≤35％作为诊断严重左心室功能衰竭的“金标准”，G-SPECT诊断准确性明显高于G-PET[（95％（59／62）与71％（44／62）;x^2=12．899，P〈0．01]。结论对于临床常规行心肌灌注显像和心肌代谢显像检测心肌存活性的LVA患者，建议2种方法均采用门控采集。对于小范围心肌灌注缺损的LVA患者，建议参考G-SPECT测定的LVEF，大范围者建议参考G-PET。以MRI测定值为标准，G-SPECT较G-PET能更准确地筛选出严重左心室功能衰竭（LvEF≤35％）的LVA患者。Objective To compare the accuracy of gated 99^Tc^m-MIBI SPECT （G-SPECT） and ga- ted 18^F-FDG PET （G-PET） for assessing LVEF in patients with left ventrieular aneurysm （LVA） by using MRI as a reference. Methods Ninety-six patients （88 males, 8 females; mean age （57±10） years） with LVA diagnosed by MRI from September 2009 to February 2012 ,who also underwent G-SPECT and G-PETwere retrospectively studied. LVEF was calculated using quantitative gated SPECT （QGS） software. Non-ga- ted SPECT and PET images were analyzed with a 17-segment model and 5-score system. A severe myocardi- al perfusion defect （MPD） was defined as absence of activity （MIBI score = 4）, and a normal segment was defined as normal radiotracer activity （MIBI score = 0）. LVEF in MRI was calculated by Simpson method. Paired-t test, Pearson correlation analysis and Bland-Altman test were used. Results （1） Patients were grouped according to the number of segments with MPD. In patients with small extent of MPD （0-2 seg- ments, n= 18）, LVEF detected by G-SPECT was correlated with that detected by MRI （r = 0.87, P〈 0. 01） , and so was LVEF detected by G-PET（r=0.91, P〈0.01）. The LVEF was overestimated by G-PET （ （ 37± 13） % vs （ 34± 10） % ; t = 2.850, P〈0.05 ）. In patients with large extent of MPD （ I〉 5 segments, n = 48） , correlations of LVEF were moderate between G-SPECT and MRI （r= 0.68 P〈0.01） , and between G- PET and MRI（r= 0.75, P〈0.01）. LVEF detected by G-SPECT was significantly lower than that by MRI （（26±8） % vs （ 30± 10） %,t = -3.992, P〈0.01 ）. （2） The diagnostic accuracy of G-SPECT to identify pa- tients with severe heart failure （LVEF ≤ 35% by MRI, n = 62） was significantly higher than that of G-PET （95% （59/62） vs 71% （44/62） ; x^2 = 12.899, P〈0.01）. Conclusions For routinely scheduled SPECT perfusion imaging and PET metabolic imaging to detect myocardial viability in LVA patients, gated acquisi- tion should be per

关 键 词：心脏室壁瘤 心室功能 左 体层摄影术 发射型计算机 单光子 体层摄影术 发射型计算机 磁共振成像 MIBI 

分 类 号：R541[医药卫生—心血管疾病] R817.4[医药卫生—内科学]