^(18)F-FDG心肌代谢显像诊断近期心肌缺血的研究  

Use of Resting Myocardial ^(18)F-FDG Imaging in the Detection of Recent Myocardial Ischemia

作　　者：李佳[1] 窦克非[1] 杨敏福[2] 谢博洽[2] 高晓津[1] 杨跃进[1] 何作祥[3] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外医院核医学科,北京市100037 [2]首都医科大学附属朝阳医院核医学科,北京市100020 [3]中国医学科学院北京协和医学院心血管病研究所阜外医院冠心病诊治中心,北京市100037

出　　处：《中国分子心脏病学杂志》2016年第1期1561-1566,共6页Molecular Cardiology of China

基　　金：首都医学发展科研基金(2014-2-4033);首都特色临床应用研究基金(Z131107002213182)

摘　　要：目的研究表明,18F-FDG是心肌缺血的敏感标记物,在诊断近期心肌缺血导致不稳定型心绞痛(unstable angina,UA)时有潜在的作用。本研究旨在探讨18F-FDG PET/CT显像诊断近期心肌缺血中的价值。方法本研究为前瞻性研究,纳入34例怀疑近期心肌缺血的患者(男女各17名,平均年龄59±6岁)。在最近一次心绞痛发作后21±9小时(2-46小时)进行静息心肌18F-FDG PET/CT显像。患者也接受了静息或运动心肌灌注显像(myocardial perfusion imaging,MPI)以及冠状动脉造影检查。"局灶性"或"弥漫并局灶性"心肌18F-FDG摄取被定义为异常,而包括基底段"局灶"摄取在内的其他形式心肌摄取被认为是正常的。近期心肌缺血的最终诊断是根据心电图、MPI和冠状动脉造影综合分析确诊的。结果 21例最终诊断为近期心肌缺血的患者中,其中18例患者的18F-FDG摄取增高(敏感性85.7%),而在13例除外近期心肌缺血诊断的患者中,只有1例患者18F-FDG摄取异常(特异性92.3%)。静息18F-FDG显像的灵敏度比静息MPI(85.7%比52.4%,P=0.016)高。此外,6例仅于运动时可诱发出缺血的不稳定心绞痛患者,静息时18F-FDG摄取异常。结论这项前导研究表明,静息18F-FDG PET/CT显像是一项可以准确、敏感识别近期心肌缺血的技术。Objective Increased myocardial glucose metabolism occurs with the onset of myocardial ischemia and may persist even after the restoration of blood flow, termed as ‘ischemic memory＇. Previous studies have demonstrated that ^18F-FDG is a sensitive marker of myocardial ischemia and may have potential utility in diagnosing recent myocardial ischemia. This study aimed to explore the value of ^18F-FDG PET/CT in diagnosing recent myocardial ischemia. Methods Thirty-four patients（17 males, mean age 59 ± 6 years） with suspected UA were prospectively recruited. Resting myocardial ^18F-FDG PET/CT imaging was performed 21 ± 9 hours（2–46 hours） after the latest onset of angina pectoris. Resting or exercise myocardial perfusion imaging（MPI） as well as coronary angiography were performed. ‘Focal＇ or ‘focal on diffuse＇ myocardial ^18F-FDG uptake was defined as abnormal, whereas other patterns of myocardial uptake including ‘focal＇ uptake on the basal segments were considered as normal. The final diagnosis of recent myocardial ischemia was based on a comprehensive analysis of electrocardiography, MPI, and coronary angiography. Results Of 21 patients with a final diagnosis of UA, 18 had increased ^18F-FDG uptake（sensitivity 85.7%）, whereas, of 13 patients without UA, only 1 had abnormal ^18F-FDG uptake（specificity 92.3%）. The sensitivity of resting ^18F-FDG imaging was higher than that of resting MPI（85.7% vs. 52.4%, P=0.016）. Moreover, 6 patients with only exercise-induced ischemia showed abnormal ^18F-FDG uptake at rest. Conclusion This pilot study demonstrated that resting 18F-FDG PET/CT imaging is an accurate and sensitive technique for the identification of recent myocardial ischemia.

关 键 词：^18F-FDG 心肌缺血 缺血记忆 

分 类 号：R542.2[医药卫生—心血管疾病]